Benign Breast Diseases - Santhosh.S
Benign Breast Diseases - Santhosh.S
Benign Breast Diseases - Santhosh.S
SANTHOSH.S
S6 UNIT
CLASSIFICATION
CONGENITAL INJURY INFLAMMATION/INFECTION
AMAZIA/ATHELIA HAEMATOMA
ANDI(Aberrations of normal
POLYMAZIA/ TRAUMATIC FAT differentiation and involution)
POLYTHELIA NECROSIS • Cyclical nodularity and mastalgia
INVERTED NIPPLE • Cysts
• Fibroadenoma
• Duct ectasia
PREGNANCY-RELATED
• Galactocele
• Lactational abscess
CONGENITAL ABNORMALITIES
AMAZIA
Congenital absence of breasts on one or both sides.
POLYMAZIA
• Accessory breasts present mostly in axilla ,they have
been known to function during lactation.
• Other sites: groin, buttock, thigh.
INVERTED NIPPLE
• Failure of mammary pit to elevate above the skin,
shortens subareolar duct leading to inversion of nipple.
• Treated manually/by surgical correction.
INJURIES TO BREAST
HAEMATOMA
• Collection of blood within the breast following trauma,
gives rise to a lump.
• If small hematoma it resolves ,if large hematoma requires drainage.
TRAUMATIC FAT NECROSIS
• Occurs as a result of trauma /surgery/radiotherapy.
• Mimics carcinoma of breast.
• Diagnosed by biopsy ,Treatment is excision.
• Histologically: Lipid laden macrophage, scar tissue, chronic
inflammatory cells.
• In MAMMOGRAPHY and USG CALCIFICATIONS(Lead pipe) present.
INFLAMMATION / INFECTION
BACTERIAL MASTITIS:
AETIOLOGY:
Most common causative agent is S.AUREUS.
ASCENDING INFECTION DUCT BLOCK MILK CLOTTING MULTIPLICATION OF ORGANISM .
If an antibiotic is given in the presence of undrained pus ,an ANTIBIOMA may form.
DD: Inflammatory carcinoma of breast.
Diagnosis: Pus aspirated and sent to bacterial culture.
DUCT ECTASIA/PERIDUCTAL MASTITIS:
Dilatation of breast ducts often associated with periductal inflammation.
Common in smokers.
PATHOGENESIS:
• Nipple discharge
• Subareolar mass
• Abscess
• Mammary duct fistula
• Nipple retraction
TREATMENT:
• Antibiotic
• Surgical excision of all major ducts
(Hadfield’s operation).
Aberration of normal development and
involution(ANDI)
ANDI involves disturbances in the breast physiology extending from pertubation of
normality to well defined disease processes.
PATHOLOGY:
Cysts formation
Fibrosis
Hyperplasia of epithelium in the lining of ducts and acini
Papillomatosis
CLINICAL FEATURES:
Lump
Mastagia
1.Cyclical mastagia
2.Non-cyclical mastagia
FIBROADENOMA
Most common benign breast lump.
Hyperplasia of single lobule [2 to 3 cm in size].
Common among 15 to 25 years of age.
CLINICAL FEATURES:
Firm, smooth, non-tender ,well localised lump.
Freely moves over the breast [breast mouse].
SUBTYPES OF FIBROADENOMA:
• Giant fibroadenoma [> 5cm].
• Juvenile fibroadenoma.
INVESTIGATION
1.USG
2.MAMMOGRAM (Popcorn calcification)
3.FNAC
TREATMENT:
1. SURGERY
Peri-areolar incision
Inframammary incision [Gillard thomas incision]
INDICATION:
Cosmetic
Giant fibroadenoma
Rapid increase in size
Family history suggestive of breast cancer
2. CRYOABLATION
3. ECHOTHERAPY
4. MAMMOTOME [LARGE CORE VACUUM BIOPSY SYSTEM]
PHYLLODES TUMOUR
Also known as “Serocystic disease of Brodie” or “Cystosarcoma phyllodes”.
Common in 4th decade of life.
CLINICAL FEATURES:
Large with unevenly bosselated surface.
Ulceration over skin can occur.
Mobile on the chest wall.
INVESTIGATION:
USG
MAMMOGRAM
BIOPSY
TREATMENT:
SURGERY:
Lumpectomy or wide local excision.
Simple mastectomy [recurrence ,massive tumour ,malignant type].
BREAST CYST
Breast cyst are due to non-integrated involution of stroma and epithelium.
Age: Last decade of reproductive life.
Cyst can be multiple, bilateral, mimic malignancy.
CLINICAL FEATURES:
Smooth, Soft lump associated with cyclical changes during mensural period.
INVESTIGATION:
USG
FNAC
CORE BIOPSY
MONDOR'S DISEASE
Thrombophlebitis of superficial veins of the breast and
anterior chest wall.
Thrombosed subcutaneous cord like structure under the skin.
A narrow, shallow ,subcutaneous groove alongside the cord.
Treatment : Restrict arm movements, anti-inflammatory
medications and warm compress.
TUBERCULOSIS OF BREAST
CLINICAL FEATURES:
1. Swelling with cold abscess, sinuses.
2. Bluish appearance of surrounding skin.
3. Matted lymph nodes in ipsilateral axilla.
PAPILLOMATOSIS:
• Hyperplasia of epithelium.