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BREAST Begashaw M (MD)

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Page 1: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

BREAST

Begashaw M (MD)

Page 2: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Introduction

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

with neoplastic disease

Page 3: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Anatomy

overly -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

Page 4: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Anatomy

Page 5: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Breast lumps

DDx

• Cancer

• Fibrocystic change

• Fibroadenoma

• Fat necrosis

• Duct ectasia

• lipoma

•TB

Page 6: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Breast cyst

Raredue to a nonintegrated involution of stroma

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

Page 7: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 8: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Fibroadenoama

Page 9: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 10: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Phyllodes Tumour

Page 11: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 12: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Clinical presentation

-Nipple discharge

-subareolar mass

-Abscess

-Mammary duct fistula/nipple retraction Treatment

-Excision of all major ducts

Page 13: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Investigation of a Breast Lump

Page 14: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Acute mastitis

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

always commences acutely associated with lactation

Causestaphylococcus aureus Clinical presentation

- Pain

- Swelling- Redness- Tenderness/hotness- abscess

Page 15: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Treatment

Antibiotics – cloxacillin Breast restbreast-feeding on the opposite

side only Support breast Local Heat/Analgesics

Page 16: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 17: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Lactational breast abscess Nonlactational breast abscess

Page 18: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Breast abscess drainage

Page 19: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Breast Carcinoma

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

In our set up, increasing incidence is being observed

Page 20: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 21: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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 %

Page 22: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Breast cancer Locally advanced breast carcinoma

Page 23: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion
Page 24: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Nipple retraction

Page 25: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 26: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 27: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

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

Page 28: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Signs of metastasis

_Lymph node enlargement

_Bone pain

_cough Chest x-ray, Serum alkaline phosphates &

liver ultrasound

Page 29: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion
Page 30: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Prognosis

- Tumor size & LN status

- Invasive & metastatic potential

- Histological grade

- Estrogen receptor status- Patient age

Page 31: BREAST Begashaw M (MD). Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions discomfort confusion

Treatment

Multi disciplinary

_Surgery

_Radiotherapy

_Medical therapy -Chemotherapy

-Hormonal therapy


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