BREAST

Begashaw M (MD)

Introduction

Modified sweat gland - produces milkBreast ca - most common cause of deathBenign conditions discomfort confusion

with neoplastic disease

Anatomyoverly -2nd – 6th rib - from lateral border of sternum

to anterior axillary line, between clavicle & to the 7th & 8th ribs below

Ligaments of cooper Areola contains involuntary muscles nipple covered by thick skin lactiferous ducts Lymphatics -axillary lymph nodes on the ipsilateral

side

Anatomy

Breast lumps

DDx• Cancer• Fibrocystic change• Fibroadenoma• Fat necrosis• Duct ectasia• lipoma•TB

Breast cyst

Raredue to a nonintegrated involution of stroma

& epitheliumoften multiple & may be bilateralDiagnosis –aspiration/ultrasoundTreatment – Aspiraton

Fibroadenoma Most common in women age < 30 C/F Nodulessmooth, rubbery, discrete, well-circumscribed, non-

tender, mobile Ixs -biopsy -ultrasound -FNA Treatment_Generally conservative: serial observation_Consider excision if size 2-3 cm & rapidly growing

Fibroadenoama

Phyllodes Tumor

_Are benign tumors_Usually occur in women over 40 years_large, massive tumor with unevenly

lobulated surface and occasionally with ulceration of overlying skin

_Treatment – Enucleation _ Simple mastectomy

Phyllodes Tumour

Ductectasia/ periductal mastitis

is dilatation of breast ducts associated with periductal inflammation

Pathogenesis _ Dilatation of lactiferous ducts filled with a

stagnant brown or green secretiondischarge _irritant reaction in surrounding tissue leading

to periductal mastitis

Clinical presentation -Nipple discharge -subareolar mass -Abscess -Mammary duct fistula/nipple retraction Treatment -Excision of all major ducts

Investigation of a Breast Lump

Acute mastitis is acute inflammation of the breast Bacterial mastitis is the commonest variety of mastitis and nearly

always commences acutely associated with lactationCausestaphylococcus aureus Clinical presentation- Pain- Swelling- Redness- Tenderness/hotness- abscess

Treatment

Antibiotics – cloxacillin Breast restbreast-feeding on the opposite

side only Support breast Local Heat/Analgesics

Breast abscess

If acute infection of breast doesn’t resolve with in 48 hours/tense induration Abscess

Fluctuation is a late signWhen doubt exists incision & drainageTreatment – incision & drainage

Lactational breast abscess Nonlactational breast abscess

Breast abscess drainage

Breast Carcinoma

is the commonest cause of death in middle-aged women in western countries

In our set up, increasing incidence is being observed

Risk Factors

_ Gender -99% Female_ Age80% >40 years old_ Prior hx of breast ca_1st degree relative_ Nulliparity, First pregnancy >30 years old, Menarche < 12

yrs old, Menopause >55 yrs old_Decreased risk with lactation,Early menopause, Early

childbirth_Radiation exposure_Obesity,Diet,Geography-western

Pathology

Arise from the epithelium of the duct system May be entirely in situ or may be invasiveGrades -Well differentiated -Moderately -Poorly differentiatedDuctal carcinoma -Most common Lobular carcinoma -10 %

Breast cancer Locally advanced breast carcinoma

Nipple retraction

Spread

Local spread: increases in size & invades,involve skin,penetrate pectoral muscles & chest wall

Lymphatic spread _Axillary lymph node _Supraclavicular nodes _Contra lateral lymph nodes Hematogenous Bone(lumbar,Femur, thoracic

vertebra, rib/skull) osteolytic) liver, lungs & brain

Clinical presentation

occurs commonly upper outer quadrant/UOQ

Local Findings_Hard, irregular lump_nipple retraction_Skin involvement with peau d’ orange_Frank ulceration & fixation to the chest wall

27

Signs and Symptoms

Most common: lump or thickening in breast. Often painless

Change in color or appearance of areola

Redness or pitting of skin over the breast, like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Signs of metastasis

_Lymph node enlargement_Bone pain_cough Chest x-ray, Serum alkaline phosphates &

liver ultrasound

Prognosis

- Tumor size & LN status- Invasive & metastatic potential- Histological grade- Estrogen receptor status- Patient age

Treatment

Multi disciplinary _Surgery _Radiotherapy _Medical therapy -Chemotherapy -Hormonal therapy