What You Will Learn
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Fibroadenoma
Well encapsulated
15 - 25 years of age
Most common
15% of palpable breast lump Common in blacks
Clinical Features:
- Painless
- Smooth
- Firm
- Well localised
- Moves freely
Investigations:
- - USS
- - Mammogram
- - FNAC
- - Core needle biopsy
Treatment: Excision
Fibrocystic Disease
Clinical Features:
- Painful, diffuse, granular
- Tender swelling
- Not attached
- Cyclical mastalgia
- Subsides during pregnancy
- Nipple discharge - greenish
Investigation:
- FNAC
- USS - Mammogram
Reassurance
Drugs:
- To relieve pain
- To reverse changes
- To soften breast
Drugs:
- Oil of primrose
- Tamoxifen
- Bromocriptine
- NSAID
Surgery: Subcutaneous mastectomy
Sclerosing Adenosis
Benign
- 30-50 years
- Diffuse or focal
- Multiple, small firm nodules
- Cyclical mastalgia
Treatment: like fibrocystic disease
Phylloides Tumour
Phylloides Tumour (Cystosarcoma Phylloides, Serocystic Disease of Brodie)
Show spectrum of activities (Benign 85%, Metastases 15%):
- Low grade
- Spread to lungs and bones
- 1% of breast tumors
Gross: Large, Capsulated, soft, brownish and cystic area
Features:
- Middle aged, usually unilateral
- Grow rapidly, attain large size
- Bosselated surface
- Skin over it is stretched
- Recurrence is common
Investigation:
- USS
- Mammogram
- Core biopsy, FNAC
- CXR
Treatment:
- Wide excision
- If Malignant - Mastectomy
Mastalgia
45% common in women
Unknown aetiology
Types:
- Cyclical (65%)
- Non-Cyclical (30%)
- Chest wall (5%)
Cyclical:
- Pain related to menses
- Seen in ANDI
- Seen menstruating age group
- Bilateral
Treatment: Diclofenac gel, evening Primrose oil, Bromocriptine, Tamoxifen, Vit. B6 B10, analgesics
Non-Cyclical:
- Periductal
- Malignancy
- Unilateral
Treatment: Identify the causes
Other Benign Breast Diseases
- Traumatic Fat Necrosis
- Galactocele
- Mastitis
- Duct Ectasia
- Hormonally induced
- Greenish nipple discharge
- Nipple retraction
- TB Breast
- Breast Cyst
- Galactorrhea
- Gynecomastia
- Estrogen excess
- Androgen deficiency
- Testicular tumor
- Neonatal
- Pubertal
- Duct Papilloma
Dilatation of ducts
Treatment: Excision of ducts involved, antibiotics
Causes:
Drugs: (digitalis, steroids)
Types:
Features: Diffuse, enlarged breast, well localized
Treatment: Surgical excision, Drugs - Tamoxifen, Clomiphene
Features: Bloody discharge from nipple
Aetiology:
- Common in developed countries than Africa
- More aggressive in African women
- Common after middle age but can occur in any age after 20 yrs
- It can be familial in 2-5% of cases
- Mutation of tumor suppressor gene BRCA 1, BRCA 2 Genes
Risk Factors:
- Diets
- Nulliparity
- Early menarche
- Late menopause
- Early child bearing
- Obesity
- First degree relative
- Radiation
- Contraceptive pills
Pathology
Breast cancer from Lactiferous duct: Ductal carcinoma
Breast cancer from lobules: Lobular carcinoma
In situ:
- Ductal in situ - DCIS
- Invasive
- Lobular in situ - LCIS
Classification:
- Non-invasive: LCIS, DCIS
- Invasive:
- Invasive lobular 10%
- Invasive ductal:
- Specified 70%
- Tubular 2%
- Colloid
- Medullary
Presentation of Breast Cancer
- Lump in the breast
- Nipple discharge
- Ulceration/fungation
- Axillary pain
- Chest pain
- Bone pain
- Liver secondaries
- Pain in the lump
Differential Diagnosis
- Fibroadenoma
- Traumatic fat necrosis
- TB
- Filariasis
- Galactocele
Investigation
- Mammogram
- USS
- FNAC
- Trucut biopsy
- Excision/incision
- MRI
- CXR
Combined Approach
- Surgery: MRM, Total mastectomy
- Radiotherapy
- Hormone therapy
- Chemotherapy
Conservative Surgery
- Wide local excision
- Skin Sparing mastectomy
- Toilet mastectomy
Practice Questions
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