Lecture notes for medical students

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Physiology

3. Physiology
Aberrations in the Normal
Differentiation and Involution of
the breast
• AKA fibrocystic disease, fibroadenosis, chronic
mastitis and mastopathy

4. Physiology
The female breast passes through 5phases
during lifetime
1. Prepubertal
2. Post pubertal
3. Pregnancy
4. Lactational
5. Menopausal

5. Physiology
• The resting (non-lactating) breast, consists
mostly of fibrous & fatty tissue
• During phases of the menstrual cycle the
breast epithelium and lobular stroma
undergo cyclic stimulation.
• Dominant process is hypertrophy and
alteration of morphology rather than
hyperplasia.

6. Physiology
• With pregnancy, there is diminution of the
fibrous stroma to accommodate the
hyperplasia of the lobular units.
• Growth is influenced by high circulating
levels of estrogen and progesterone and
prolactin .

7. Physiology
• After childbirth, there is a sudden loss of the
placental hormones.
• A continued high level of prolactin is the
principal trigger for lactation.
• The actual expulsion of milk is under
hormonal control and is caused by the
contraction of the myoepithelial cells by
hormone Oxytocin.
• Stimulation of the nipple is the physiologic
signal for both the continued pituitary
secretion of prolactin and for the acute
release of oxytocin.

8. Physiology
• When breast-feeding ceases, there is a fall
in prolactin and no stimulus for release of
oxytocin. The breast then returns to a
resting state and to the cyclic changes
induced when menstruation begins again.

9. Physiology
• After menopause progressive atrophy of
lobes & ducts takes place – Involution.
• These changes include increased fat
deposition, diminished connective tissue,
and the disappearance of lobular units.

10. ANDI

11. ANDI
Age group :30-50 years
Aberration in normal cyclical hormonal
effects
Cyclcial mastalgia with nodularity

12. ANDI Classification of Benign Breast
Disorders
Normal Disorder Disease
Early reproductive
years (age 15–25)
Lobular development Fibroadenoma Giant fibroadenoma
Stromal development Adolescent hypertrophy Phhyllodes tumor
Nipple eversion Nipple inversion Subareolar abscess
Mammary duct fistula
Later reproductive
years (age 25–40)
Cyclical changes of
menstruation
Cyclical mastalgia Incapacitating mastalgia
Nodularity
Epithelial hyperplasia of
pregnancy
Bloody nipple discharge
Involution (age 35–55) Lobular involution Macrocysts
Sclerosing lesions
Duct involution
–Dilatation Duct ectasia Periductal mastitis
–Sclerosis Nipple retraction
Epithelial turnover Epithelial hyperplasia Epithelial hyperplasia with atypia

13. Benign Breast Disease

14. Etiology

15. Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative

16. Idiopathic

17. Idiopathic
• Mondor’s disease
• Duct ectasia/periductal mastitis
• ANDI
• Breast cysts
• Galactocele
• Fibroadenoma
• Phyllodes tumour

18. Congenital

19. Congenital
Nipple
• Nipple retraction
• Cracked nipple
• Papilloma of the nipple
• Retention cyst of a gland of Montgomery
• Eczema
• Discharges from the nipple

20. Congenital
Breast
• Amazia
• Polymazia
• Mastitis of infants
• Diffuse hypertrophy

21. Traumatic

22. Traumatic
• Haematoma
• Traumatic fat necrosis

23. Infections

24. Infections
• Bacterial mastitis and Abscess.
• Chronic intramammary abscess
• Tuberculosis of the breast
• Actinomycosis

25. Clinical Features

26. Clinical Features
• Pain
• Lump
• Nipple discharge

27. Triple Assesment

28. Triple Assesment
• Clinical Assessment
• Imaging Studies
• Histopathology

29. Diagnostic Studies

30. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Nuclear scan

31. Fibroadenoma

32. Fibroadenoma
• Second most common tumor of breast
• ANDI
• Represent a hyperplastic or proliferative process in a
single lobule
• Etiology is unknown, thought to be due to hormonal
influence
• Between the ages of 15-25 years & size of 2-3cm
• Painless lump- capsulated,smooth, firm, well defined,
nontender, BREAST MOUSE
• Microscope-
intracanalicular pericanalicular

33. Fibroadenoma
• Treatment-conservative
• Surgery -
– Very large/increasing in size
– Suspicious cytology
– Surgery is desired.
– Enucleation

34. PHYLLODES TUMOUR

35. PHYLLODES TUMOUR
• Proliferation of intralobular stroma
• Fusiform fibroblast
• 3 types:-
benign
borderline
malignant
(cellularity,atypia,mitoses &invasion by
edges)

36. Management

37. Management
Wide local excision
Benign
Borderline - Follow up
Malignant -SIMPLE MASTECTOMY

38. Traumatic Fat Necrosis

39. Traumatic Fat Necrosis
• Clinical features - Pain & lump in the breast
• Lump is hard - extensive fibrosis caused by
tissue reaction
• D.D : Carcinoma breast
• Mammography findings - density lesion;
can have calcifications; may mimic
carcinoma breast
• Treatment - excision of the lump

40. Breast cyst

41. Breast cyst
 Age group – 30-50
• Multiple and bilateral
• Can mimic malignancy
• Confirmed by USG and
aspiration

42. Breast cyst
 Aspirate
 Excision biopsy if-
Bloody aspiration
Residual mass
Suspicious cytology
Recurs

43. MASTALGIA

44. MASTALGIA
• Menstruating age group
• Hormone related-ANDI
• Dull diffuse bilateral
• Upper outer quadrant

45. MASTALGIA:MANAGEMENT
•

46. MASTALGIA:MANAGEMENT
• 1.Pain diary
• 2.Reassurance
• 3.Exclude caffeine
• 4.Low fat diet
• 5.Stop OCPs/HRT
• 6.stop smoking
• 7.drugs

47. MASTALGIA:Drugs

48. MASTALGIA:Drugs
• ANALGESICS
• EVENING PRIM ROSE OIL
• GOSERELIN
• BROMOCRIPTIN
• DANAZOL

49. Duct Papilloma

50. Duct Papilloma
• Proliferative breast disease without atypia
• Polyps of epithelium lined duct
• Bloody discharge
• Microdochectomy

51. Duct ectasia
• Dilatation of the breast ducts associated
with chronic inflammatory response in the
periductal tissue
• Greenish discharge
• Duct excision

52. Breast Abscess /Mastitis

53. Breast Abscess /Mastitis
• Flucloxacillin or co-amoxiclav
• Support of the breast,local heat,&
analgesics
• Incision & drainage
• Now recommended is repeated aspiration
under antibiotics
• continue breast feeding

54. MONDOR’S DISEASE

55. MONDOR’S DISEASE
• Thromboplebitis of superficial veins of the breast
& chest wall
• Aetiology not known
• C/F – thrombosed subcutaneous cord
• DD – breast cancer
• Treatment – anti-inflammatory medication
warm compresses & support
restriction of movement
symptoms persist - excision

56. Virginal Hypertrophy

57. Virginal Hypertrophy
• Huge enlargement.
• Reduction mastoplasty
• Mastectomy

58. Get this ppt in mobile
1. Download Microsoft
PowerPoint from play
store.
2. Open Google assistant
3. Open Google lens.
4. Scan qr code from
next slide.

59. Get this ppt in mobile

60. Get my ppt collection
• https://www.slideshare.net/drpradeeppande/
edit_my_uploads
• https://www.dropbox.com/sh/x600md3cvj8
5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl
=0
• https://www.facebook.com/doctorpradeeppa
nde/?ref=pages_you_manage