18-Benign_Breast_Disease

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Benign Breast DiseaseS:

Benign Breast DiseaseS BY B.Balakrishna 8 th Term, Roll.No-18 Under guidance of Dr.M.Shivakumar Professor &unit head Dept ofsurgery5 th unit

Outline:

Outline Anatomy Benign Breast disease Anamolies

Anatomy:

Anatomy Modified sweat gland between the superficial and deep layers of the chest wall Cooper’s Ligament Fibrous band of tissue connects breast to the overlying skin above & underlying pectoralis fascia.

Anatomy:

Anatomy Ducts Terminal ductules Milking forming glands Lobule

Anatomy:

Anatomy Hormonal Effects Estrogen Development of the breast and lactiferous ducts Progesterone Secretory acinar tissue – lobules Prolactin Synergizes the effect of estrogen and progesterone

CLASSIFICATION OF BENIGN BREAST DISEASES :

CLASSIFICATION OF BENIGN BREAST DISEASES 1)DUCT ECTASIA/PERIDUCTAL MASTITIS 2)PREGNANCY RELATED GALACTOCELE 3)ANDI(ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION) CYCLICAL NODULARITY & MASTALGIA CYSTS FIBROADENOMA 4)PHYLLODES TUMOUR 5)CONGENITAL DISORDERS INVERTED NIPPLE SUPERNUMERARY BREASTS/NIPPLES TIETZE’S DISEASE SEBACEOUS CYSTS

DUCT ECTASIA OR PERIDUCTAL MASTITIS:

DUCT ECTASIA OR PERIDUCTAL MASTITIS THIS IS A DILATATION OF BREAST DUCTS THE CLASSICAL DESCRIPTION OF THE PATHOGENISIS OF DUCTECTASIA ASSERST THAT THE FIRST STAGE IN THE DISORDER IS A DILATATION IN ONE OR MORE OF THE LARGER LACTIFEROUS DUCTS THAT FILL WITH A STAGNANT BROWN OR GREEN SECRETION. THESE FLUIDS THEN SETUP AN IRRITANT REACTION IN SURROUNDING TISSUES LEADING TO PERIDUCTAL MASTITIS OR EVEN ABSCESS AND FISTULA FORMATION

GALACTOCELE:

GALACTOCELE Galactocele usually presenta as a solitary subareolar cyst and always from lactation It contains milk and in long standing cases its walls tend to calcify. It can become enormous in size. PREGNANCY RELATED

ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION:

ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION NOMENCLATURE:- The nomenclature of benign breast disease is very confusing because over a last century a variety of clinicians and pathologists have chosen to describe a mixture of physiological changes and disease process acc to the variety of clinical , pathological and aetiological terminology. To sort of this confusion a new system has been developed by cardiff breast clinic i.e is ANDI(ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION)

AETIOLOGY:

AETIOLOGY The breast is a dynamic structure that undergoes changes throughout a woman’s life and, superimposed upon this cyclical changes throughout the menstrual cycle.

PATHOLOGY:

PATHOLOGY This disease consists of especially four features that may vary in extent and degree 1)Cyst formation:-almost inevitable and variable in size 2)Fibrosis:-Fat & elastic tissue disappears and is replaced with dense white fibrous trabeculae. The interstitial tissue infiltrated with the chronic inflammatory cells 3)Hyperplasia:-of epithelium in the lining of the ducts and acini may occur with or without atypia 4)Papillomatosis:-The epithelial hyperplasia may be so extensive that it results in papillomatous overgrowth within the ducts.

CLINICAL FEATURES:

CLINICAL FEATURES The symptoms of ANDI include an area of lumpiness(seldom discrete )and/breast pain (mastalgia) The benign discrete lump in the breast is commonly a cyst . Lumpiness may be bilateral commonly in the upper outer quadrant or less commonly, confined to one quadrant of one breast Non –cyclical mastalgia is commoner in perimenopausal than post-menopausal women. It is unilateral . Cyclical mastalgia is related to menstrual cycle seen in women of menstruating age group , bilaterally diffuse with “heavy feeling” pain is seen more during menstruation.

BREAST CYSTS:

BREAST CYSTS THIS OCCURS MOST COMMONLY IN THE LAST DECADE OF REPRODUCTIVE LIFE DUE TO A NON-INTEGRATED INVOLUTION OF STROMA AND EPITHELIUM Fluid-filled 1 out of every 14 women 50% multiple and recurrent Hormonally influenced Needle aspirated

FIBROADENOMA:

FIBROADENOMA THIS USUALLY OCCURS IN THE FULLY DEVELOPED BREAST DURING THE 15 -25 YEAR PERIOD ALTHOUGH OCCASIONALY IN THE ELDER WOMEN They arise from the hyperplasia of a single lobule and grows upto 2-3cm in size & surronded by well enucleated capsule . Firm, solitary tumors Multiple Increase in size Management Biopsy Excisional biopsy

Phyllodes tumour:

Phyllodes tumour Phyllodes Tumor are sometimes known as serocystic disease of brodie or cystosarcoma phylloides. - usually occurs in women in the age group of 40 due to Proliferation of connective tissue with ductal elements Whorled and cellular stroma Firm, lobulated 2 to 40 cm in size 10% malignant Treatment Wide excision

CONGENITAL DISORDERS:

CONGENITAL DISORDERS SUPERNUMERARY BREAST also known as polymastia , multiple breast syndrome , or mammae erraticae , is the condition of having an additional breast. Extra breasts may appear with or without nipples or areolae. It is a condition and a form of atavism which is most prevalent in male humans, and often goes untreated as it is mostly harmless. In recent years, many affected women have had a plastic surgery operation to remove the additional breasts.

Inverted nipple:

Inverted nipple TEITZ’S DISEASE :- Costochondritis of 2 nd coastal cartilage. Commonly seen in females ,mimics mastalgia

PowerPoint Presentation:

CONGENITAL ANAMOLIES AMAZIA POLYMAZIA MASTITIS OF INFANTS DIFFUSE HYPERTROPHY ACCQUIRED ANAMOLIES:- INJURIES OF BREAST HEMATOMA TRAUMATIC FAT NECROSIS ACUTE &SUBACUTE INFLAMMATIONS OF THE BREAST BACTERIAL MASTITIS MASTITIS FROM MILK ENGORGEMENT CHRONIC INFLAMMATORY ABSCESS TUBERCULOSIS OF BREAST ACTINIMYCOSIS SYPHILIS OF BREAST MONDOR’S DISEASE ANAMOLIES OF BREAST

PowerPoint Presentation:

amazia polymazia Diffuse hypertrophy Mastitis of infants CONGENITAL ANAMOLIES

AMAZIA:

AMAZIA IT IS CONGENITAL ABSENCE OF BREAST ON ONE OR BOTH SIDES SOMETIMES IT IS ALSO ASSOCIATED WITH ABSENCE OF STERNAL PORTION OF PECTORALIS MAJOR KNOWN AS POLANDS SYNDROME.

POLYMAZIA:

POLYMAZIA IT IS THE DEVELOPMENT OF ACCESSORY BREASTS IN THE AXILLA, GROIN ,BUTTOCK AND THIGH THEY HAVE BEEN KNOWN TO FUNCTION DURING LACTATION.

MASTITIS OF INFANTS:

MASTITIS OF INFANTS THIS OCCURS AS COMMON IN BOYS AS IN GIRLS HERE DURING 3 rd OR 4 th DECADE OF LIFE IF BREAST OF AN INFANT IS PRESSED LIGHTLY A DROP OF COLOURLESS FLUID IS EXPRESSED AND A FEW DAYS LATER THERE IS OFTEN SLIGHTLY MILK SECRETION WHICH DISAPPEARS DURING 3 rd WEEK. THIS IS DUE TO STIMULATION OF FETAL BREAST BY PROLACTIN.

DIFFUSE HYPERTROPHY:

DIFFUSE HYPERTROPHY IT OCCURS IN HEALTHY GIRLS AT PUBERTY OR AT THE AGE OF PREGNANCY. THIS CONDITION ATTAINS ENORMOUS DIMENSIONS RECHING UP TO THE KNEES IN SITTINFG POSITION THIS TREMENDOUS OUTGROWTH IS APPARENTLY DUE TO AN ALTERATION IN THE NORMAL SENSITIVITY OF THE BREAST TO THE OESTROGENIC HORMONES

INJURIES OF THE BREAST:

INJURIES OF THE BREAST HEMATOMA :-PARTICULARLY A RESOLVING HEMATOMA GIVES RISE TO A LUMP,WHICH IN THE ABSENCE OF OVERLYING BRUISING IT IS DIFFICULT TO DIAGONISE CORRECTLY UNLESS IT IS ASPIRATED OR INCISED TRAUMATIC FAT NECROSIS:- IT MAY BE ACUTE OR CHRONIC AND USUALLY OCCURS IN STOUT MIDDLE AGED WOMEN IT OCCURS FOLLOWING A BLOW OR A INDIRECT VOILENCE (LIKE CONTRACTION OF PECTORALIS MAJOR)

PowerPoint Presentation:

IN SOME CASES A CHRONIC INDURATED MASS FORMS BENEATH THE AREOLA WHICH MIMICS A CARCINOMA. FIBROSIS EVENTUALLY DEVELOPS WHICH MAY CAUSE SLIT LIKE NIPPLE RETRACTION.

ACUTE AND SUB-ACUTE INFLAMMATIONS OF THE BREAST:

ACUTE AND SUB-ACUTE INFLAMMATIONS OF THE BREAST -Most common associated with lactation , infected hematoma , periductalmastitis ETIOLOGY:-commonest organism is staphylococcus transmission by 1)cleansing baby’s mouth 2)ascending infection from a sore or cracked nipple BACTERIAL MASTITIS

Clinical features:

Clinical features Early features:- classical signs of inflammation & generalised cellulitis Later features:- abscess

PowerPoint Presentation:

Mastitis from milk engorgement :- - More during time of weaning & early during lactation. - it is due to obstruction of lactiferous duct by epithelial debris C/F:-Sector of breast becomes indurated and tender Chronic inflammatory abscess :- -due to inadequate drainage or injudicious antibiotic treatment . -definitive diagnosis by histological evidence

PowerPoint Presentation:

Tuberculosis of breast :-usually associated with active pulomonary tuberculosis /cervical lymphadenitis More in parous women C/F:- -Multiple chronic abscess /sinus -Typical bluish appearance of surrounding skin. Actinomycosis:- rare condition Syphilitic breast ;- rare condition

MONDORS DISEASE:

MONDORS DISEASE Thrombophlebitis of sup veins of the breast and the anterior chest wall CAUSES:- -Idiopathic -injury -infection C/F:-Thrombosed subcutaneous cord usually attached to skin -skin over the breast is streched by raising the arm then narrow shallow subcutaneous groove along side the cord becomes apparant

BENIGN BREAST DISEASES IN MALE:

BENIGN BREAST DISEASES IN MALE GYANECOMASTIA:- Gynecomastia is a benign and usually self-limited condition that occurs in 50%-60% of boys during early adolescence. Physical examination findings vary from discrete, 1- to 3-cm, round, mobile, and usually tender masses located just underneath the areola to diffusely enlarged breasts. As the male does not contains secretory lobules the enlargement is mainly due to proliferation of ducts & increased periductal stroma. Mainly occurs in response to hormonal stimulation mainly oestrogen. This condition in the age group of 13 & 17 known as pubertal gynaecomastia. Over the age group of >50 yrs known as scnecent gynaecomastia The differential diagnosis for gynecomastia includes Klinefelter syndrome, testicular feminization, hormone-secreting tumors, hyperthyroidism, hypothyroidism, cirrhosis, drug use (eg, cimetidine, marijuana), familial predisposition, and obesity.

Referrence:

Referrence BAILEY & LOVE’S OF SURGERY SRB’S MANUAL OF SURGERY(SRI RAM BHAT) HARRISON’S TEXTBOOK OF PATHOLOGY

PowerPoint Presentation:

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