Benign Breast Diseases
Benign Breast Diseases
Benign Breast Diseases
What is ANDI
Aberration in normal development and involution. Most benign disorders are related to normal process of reproductive life. There is a spectrum that ranges from normal to aberration and occasionally to disease
Pathology of ANDI
1. Cyst formation 2. Fibrosis- fat and elastic tissue disappear and is replaced by dense white fibrous trabeculae 3. Hyperplasia of epithelium in the lining of the ducts and acini may occur 4. Papillomatosis
Stage
Fibroademona Lobular development, Early reproductive (15-25yrs) Stromal development, Nipple eversion Adolescent hypertrophy, Nipple inversion
Giant fibroadenoma
Stage
Incapacitating mastalgia
Stage
Involution (35-55yrs)
Macrocysts sclerosing lesions, Duct ectasia Nipple retraction, Simple epith. Hyperplasia
Periductal mastitis
Non ANDI
These include conditions of well define etiology. Ex. fat necrosis, breast abscess.
Breast lumps
1. Normal breast nodularity or cyclical nodularity
Upper quad and axillary tail. Assessment is clinical, supplemented by USG cytology or core needle histology. Excisional biopsy if doubt persists.
Fig: Fibroadenoma A: Cut surface - lobulated, solid, and gray-white B: Histologically the lesion consists of densely fibrotic stroma and compressed cleft-like ducts.
Triple Assessment
Mastalgia
1. Cyclical
Related to menstrual cycle. Duration of >1 week per cycle is significant and called pronounced symptoms. Etiology
Hyperprolactenemia Increase level of estrogen after ovulation Abnormality of prostaglandin secondary to deficient essential fatty acid intake in diet.
Mastalgia cont
2. Non Cyclical Mastalgia
True non cyclical mastalgia Chest wall pain
Mastalgia cont..
T/T
Non Medical Measures Reassurance breast support dietary measures
Medical Measures NSAIDS-topical application Evening primrose oil Danazol Bromocriptine Tamoxifen Nerve blocks
Planning of treatment
Cyclical evening primrose oil
danazol bromocriptine
Noncyclical danazol
bromocriptine and EPO
Nipple discharge
1. Discharge from single duct Blood stained
Intraductal carcinoma intraductal papilloma Duct ectasia fibrocystic disease duct ectasia carcinoma
Serous
Grumous
Purulent Serous
Duct Ectasia
Dilation of ducts associated with periductal inflammation. Presented as nipple discharge, sub areolar mass, abscess, mammary fistula and/or nipple retraction. t/t -rule out malignancy if lump or nipple retraction. -if suspicion remain excisional biopsy -excision of all major ducts.
Infections
Bacterial mastitis -cellulitic stage -abscess formn Tuberculosis Actinomycosis Syphilis
Benign vs malignant
Step 2: Now, raise your arms and look for the same changes. Step 3: While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.
Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower
THANK YOU