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Benign breast disease

Development of breast and benign breast disease

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Benign breast disease

  1. 1. BENIGN BREAST DISEASES Presented By : Dr MK Tiwari
  2. 2. EMBRYOGENESIS 2
  3. 3. EMBRYOGENESIS 3
  4. 4. Puberty: The morphological structure of Human Breast is identical in males and females until Puberty The 5-stage Tanner Scale shows the development stages of Secondary Sex characteristics when the female sex hormones (principally Estrogen) in conjunction with growth hormone promote sprouting, growth and development of breast of pubescent girls in Thelarche. Ref:http://en.m.wikipedia.org/wiki.Breast EMBRYOGENESIS
  5. 5. PHYSIOLOGY OF BREAST • Lobular Development • Cyclical Hormonal Change • Involution 6
  6. 6. PHYSIOLOGY OF BREAST • Lobular Development • Cyclical Hormonal Change • Involution 7
  7. 7. HORMONES IN MAMMOGENESIS • Estrogen • Progesterone • Growth Hormone • Human Placental Lactogen • Prolactin • Insulin • Glucocorticoids 8
  8. 8. 9 HORMONES IN MAMMOGENESIS
  9. 9. 10 HORMONES IN MAMMOGENESIS
  10. 10. PREGNANCY 11 Progesterone • Growth and branching of Ductal system • Fat deposition in stroma Estrogen • Growth of Alveolar Lobular System • Secretory changes in Epithelial Cells
  11. 11. COMMON BREAST CONDITIONS 12
  12. 12. ETIOPATHOGENESIS  Endocrine Factors: • Hypothalamo-pituitary-gonadal axis • Altered prolactin levels  Non endocrine factors: • Methyl-Xanthines stress • Diet rich in saturated fatty acid • Insulin resistance • Iodine deficiency 13https://www.sciencedirect.com/science/article/pii/0304383590901987
  13. 13. CLASSIFICATION  CONGENITAL • Amazia, Polymazia • Sperneumerary Breast/Nipple  ANDI  INFECTION  INJURY • Fat Necrosis  PREGNANCY RELATED • Galactocele • Puerperal Abscess 14
  14. 14. PATHOLOGICAL CLASSIFICATION  Non-proliferative : No increased risk • Cyst • Duct ectasia • Mastitis • Hyperplasia • Fibrosis • Metaplasia 15NCCN guidelines 2018
  15. 15. PATHOLOGICAL CLASSIFICATION  Proliferative : RR(1.5-2.0) • Fibroadenoma • Papilloma • Sclerosing adenosis • Hyperplasia  Proliferative with Atypia : RR (4.5-5.0) • Atypical ductal hyperplasia • Atypical lobular hyperplasia 16NCCN guidelines 2018
  16. 16. ABERRATION OF NORMAL DEVELOPMENT AND INVOLUTION(ANDI) 18
  17. 17. PRESENTATION & ASSESSMENT  Symptoms • Lump • Pain • Discharge  Triple assessment: • Clinical examination • Imaging • Pathology 19
  18. 18. LUMP 20
  19. 19. FIBROADENOMA 21 • Giant • Juvenile • Myxoid  Types: https://www.ncbi.nlm.nih.gov/pubmed/28513873
  20. 20. IMAGING 22
  21. 21. MANAGEMENT PROTOCOL 23 Fibroadenoma(Clinical Diag) Tripple assessment Multiple Giant/Juvenile Age>30yrs Results do not concur Age<30yrs All results concur Observe Wide local excision Excision of largest Extra-capsular Excision No change in size Increase in size SBE Excision
  22. 22. PHYLLODES TUMOUR 24
  23. 23. IMAGING 25
  24. 24. IMAGING 26
  25. 25. MANAGEMENT 27
  26. 26. 28 FIBROADENOMA & PHYLLODES TUMOUR
  27. 27. BREAST CYSTS  Types • Apocrine • NonApocrine • Mixed  50% Solitary  30% 3-5  Rest >5 29
  28. 28. 30 BREAST CYSTS CLASSIFICATION
  29. 29. IMAGING 31
  30. 30. IMAGING 32
  31. 31. 33 BREAST CYSTS CLASSIFICATION
  32. 32. MANAGEMENT 34 Clinical diagnosis : Cyst Needle Aspiration Blood Stained Straw coloured FNAC/Excision Bx No RecurrenceRecurrence Excision Bx Follow up
  33. 33. MASTALGIA 35
  34. 34. 36 MASTALGIA
  35. 35. MANAGEMENT 37 • Assess type of pain • Assess severity of pain ( Pain diary + Visual analogue scale ) • Evaluation with Triple assessment • Treatment :  Reassurance is the key to management  Use of supportive undergarments  Low fat, Methyl xanthine restricted diet  Stop Oral contraceptives / HRT etc  Review patient. Sucessful in the majority ( 80 – 85 % ) of patients  Start drugs in those not responding to nonpharmacological treatment  Review and assess response
  36. 36. MANAGEMENT 38
  37. 37. MANAGEMENT 39
  38. 38. DRUGS IN MASTALGIA 40
  39. 39. NIPPLE DISCHARGE 41 Causes of nipple discharge Benign (common) Malignant (less common) •Physiological causes •Intraductal papilloma and associated conditions •Blood stained nipple discharge of pregnancy •Galactorrhoea •Periductal Mastitis •Duct Ectasia •In situ carcinoma (DCIS) •Invasive carcinoma
  40. 40. CHARACTERISTICS OF NIPPLE DISCHARGE 42
  41. 41. MANAGEMENT 43
  42. 42. MANAGEMENT 44
  43. 43. BREAST ABSCESS 45
  44. 44. BREAST ABSCESS 46 1. Lactational infections  Diminishing incidence  Usually caused by S.aureus  Clinical features : Pain, redness, swelling, tenderness & systemic symptoms Treatment :  Antibiotics (E.G. Flucloxacillin, Coamoxyclav etc) before pus formation  Abscess : Repeated aspiration / mini incision with topical anaesthetic cream ( I& D under GA occasionally)  May continue to breast feed 2. NonLactational infections : Central  Usually due to Periductal mastitis  Affects younger women. Often smokers in the West  May present as : inflammation +/- mass, abscess, mammary duct fistula  Aerobic + anaerobic organisms may be involved Treatment :  Antibiotics (E.G. Co amoxyclav etc) before pus formation  Abscess : Repeated aspiration / mini incision with topical anaesthetic cream ( I& D under GA occasionally)  MDF : Excision fistula + Total duct excision
  45. 45. 47 CLINICAL CLASSIFICATION OF PERIDUCTAL MASTITIS
  46. 46. MANAGEMENT 48
  47. 47. COMPLICATION OF I & D • Mammary Duct Fistula • Inverted Nipple 49
  48. 48. PAPILLOMAS • Discrete Ductal Papilloma • Multiple Ductal Papilloma • Juvenile Ductal Papilloma 50
  49. 49. DUCT ECTASIA • Periductal Mastitis • Nipple Discharge • Abscess • Fistula • Nipple Retraction • Mass 51
  50. 50. DUCT ECTASIA 52
  51. 51. OTHER BENIGN BREAST CONDITIONS 53
  52. 52. GALACTOCELE • Retention Cyst Subareolar region • Lactating women • Obstruction of Laticiferous duct • Massive enlargement of Laticiferous sinus • Soft fluctuant mass • Risk of infection • Excision 54
  53. 53. GALACTOCELE 55
  54. 54. NIPPLE CHANGES 56 Causes : 1. Developmental inversion 2. Acquired inversion  Periductal Mastitis  Duct Ectasia (classical slit retraction)  Juxta Areolar Carcinoma with recent & fixed nipple retraction  Paget’s disease  Dry & scaly variety  Moist & eczematoid  Erosion of nipple  Thickening / macroscopically normal nipple 3. Rare problems : Adenoma, Papilloma
  55. 55. MANAGEMENT OF NIPPLE RETRACTION 57
  56. 56. TRAUMATIC FAT NECROSIS 58
  57. 57. GYNAECOMASTIA 59
  58. 58. 60
  59. 59. 61
  60. 60. CONCLUSION 62 Benign breast disorders & diseases are common The aetiopathogenesis is complex and not fully understood The ANDI classification is a unifying concept Histological risk factors for future malignancy are relative and not absolute risk factors Lump and pain are the most common complaints Evaluation is done by Triple assessment Treatment is based on the natural history of clinical problems Management algorithms are general guidelines Treatment must be tailored to individual needs
  61. 61. THANK YOU 63

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