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THE BREAST

THE BREAST. Dr.JAMIL SAWAKED. ANATOMY. TERES MAJOR. LATISSIMUS DORSI. SERRATUS ANTER. FAT. LOBE. MAJOR LACT.DUCT IS THE SITE OF DUCTAL CA . RIBS &intercost.m. AMPULLA. PECTORALIS MAJOR. 20 MAJOR LACT.ORIFICES. LACTOCYTE. THEIR CONTRACTION CAUSES SKIN DIMPLING.

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THE BREAST

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  1. THE BREAST Dr.JAMIL SAWAKED

  2. ANATOMY TERES MAJOR LATISSIMUSDORSI SERRATUS ANTER

  3. FAT LOBE MAJORLACT.DUCT IS THE SITE OF DUCTAL CA. RIBS &intercost.m AMPULLA PECTORALIS MAJOR 20 MAJOR LACT.ORIFICES LACTOCYTE

  4. THEIR CONTRACTION CAUSES SKIN DIMPLING PEAU d`ORANGE IS DUE TO OEDEMA OF SKIN LYMPHATIC

  5. DUCT SYSTEM MAJORDUCT

  6. [MINOR] OR [ TERMINAL] MINOR DUCT ISTHE SITEOF LOBULARCARCINOMA

  7. APICAL CENTRAL SUPERIORTHORACIC V. LATERAL SUBSCAP.V INTERNALMAMMARY L.N. RPOSTERIO PECTORAL LAT.THOR.V SENTINELL.N LONG THORACIC N 85% OF THEBREAST DRAININTOTHE AXILLA

  8. IF IT IS FILLED WITH MILK IT IS GALACTOCELE

  9. MASTITIS;PLUGGED DUCT OR CRACKED NIPPLE,[STAPHYLLOCOCCI] ABSCESS

  10. 60% OF MASTITIS IN LACTATING WOMEN

  11. TYPES OF MASTITIS • MASTITIS NEONATORUM • MASTITIS OF PUBERTY • LACTATING MASTITIS • SPECIFIC MASTITIS; • 1-T.B MASTITIS • 2-SYPHILITIC MASTITIS • 3-ACTINMYCOSIS

  12. BENIGN BREAST DISEASE • FIBROADENOMA • FIBROCYSTIC DIS • DUCTECTASIA • BENIGN CYSTS • LIPOMA:VERY RARE [DANGEROUS TO DIAGNOSE LIPOMA]

  13. FIBROADENOMA BREAST MOUSE SMALL ONES COULD BE LEFT ALONE

  14. Giant fibroadenoma> 5 CMCAN BECOME MALIGNANT

  15. DUCTECTASIA

  16. CYSTOSARCOMA PHYLLOIDES • THOUGHT TO BE MALIGNANT [NOTICE THE NAME] BUT IT IS NOT. MAY REACH HUGE SIZE &ULCERATE HOWEVER THERE ARE WORRYING MITOTIC FIGURES SOMETIMES DENOTING MALIGNANT POTENTIAL

  17. FIBROCYSTIC DISEASE[ANDI]

  18. BLUE DOMED CYST

  19. WHEN A BENIGN BREASTDISEASE BECOMES WORRYING? • WHEN A PATHOLOGY SPECIMEN SHOWS ATYPICAL HYPERPLASIA • FLORID HYREPLASIA CARRIES AMILD RISK • NB;METAPLASIA AND MILD HYPERPLASIA CARRY NO RISK

  20. CYSTS • ANDI • LYMPHATIC CYSTS • HYDATID CYST • GALACTOCELE • SEROCYSTIC DISEASE OF BRODIE • INTRACYSTIC PAPILLIFEROUS CA • COLLOID DEGENERATION OF CA. • PAPILLARY CYSTADENOMA

  21. CYSTS • BENIGN • MALIGNANT MANAGEMENT OF A CYST ASPIRATE & OPERATE OR CORE BIOPSY IF; 1-BLOODY ASPIRATE 2-DID NOT DISAPPEAR COMPLETELY AFTER ASPIRATION 3-RECURES IN 6 WEEKS

  22. NIPPLE DISCHARGE • I=NONBLOODY; 1-FIBROCYSTIC DISEASE 2-DUCTECTASIA • II=BLOODY; 1-DUCTECTASIA; COMMON 2-DUCT PAPILLOMA; MOST COMMON 3-DUCT CARCINOMA;VERYRARE

  23. BLOODY NIPPLE DISCHARGE

  24. NORMAL DUCT DUCT PAPILLOMA

  25. MICRODOCHECTOMY FOR BLEEDING NIPPLE BLEEDING SEGMENT IS REMOVED AND SUBMITTED TO HISTOPATHOLOGY PROBE DETERMINE FIRST WHICH ORIFICE OR SEGMENT IS BLEEDING BY PRESSING AROUND THE AREOLA

  26. BREAST CANCER • DUCTAL CARCINOMA [90%] • LOBULAR CARCINOMA[<10%] • PAGET`S DISEASE • INTRACYSTIC PAPILLIFEROUS CA • SARCOMA

  27. What Are the Risk Factors for Breast Cancer? • 1-Age; INCREASING AGE • 2-Race;WHITE++.RARE IN JAPAN, • 3-Individual or family history of breast cancer • 4-A history of ovarian cancer • 5-A genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers) • 6-Estrogen exposure;MENARHE,MENOPAUSE • 7-Atypical hyperplasia of the breast • 8-Lobular carcinoma in situ (LCIS) • 9-Lifestyle factors (obesity, lack of exercise, alcohol use) • 10-Radiation • 1-Age; INCREASING AGE • 25:1/20,000.45:1/100.50:1/50.55:1/33.60:1/24. 80:1/10. • 2-Race;WHITE++.RARE IN JAPAN, • 3-Individual or family history of breast cancer • 4-A history of ovarian cancer • 5-A genetic predisposition (mutations to the BRCA1 or BRCA2 genes cause 2% to 3% of all breast cancers) • 6-Estrogen exposure;MENARHE,MENOPAUSE • 7-Atypical hyperplasia of the breast • 8-Lobular carcinoma in situ (LCIS) • 9-Lifestyle factors (obesity, lack of exercise, alcohol use ) • 10-Radiation

  28. About 15%?[3-15]of breast cancers are inherited Approximately 80% of hereditary breast cancer is caused by mutations in the BRCA1 or BRCA2 genes.P53 has a role too Women who inherit a BRCA mutation have a 50% to 85% chance of developing breast cancer in their lifetime Women with especially strong family history may consider preventive surgery to remove breast tissue and/or chemoprevention Several other genetic syndromes can increase breast cancer risk

  29. SITES RT. LT. LT.BREAST 60 60 12% 60% 6 6 12% 10% 6%

  30. MODE OF SPREAD OF DUCTAL CARCINOMA • LOCAL • LYMPHATIC • BLOOD; BONE SOFT TISSUE 1-LUMBER V. 1-LIVER 2-FEMUR 2-LUNG 3-THORAC V. 3-BRAIN 4-RIBS 4-KIDNEY 5-SKULL 5-ADRENALS

  31. DIAGNOSIS TRIPLE ASSESSMENT • 1-CLINICAL: A-AGE . B-EXAMINATION • 2-IMAGING : A-US . B-MAMMOGRAM • 3-PATHOLOGY: A-FNA. B-CORECUT

  32. FNA & CORECUT • FNA [CYTOLOGY EXAMINATION] HAS 5% FALSE –VE MOSTLY DUE TO SAMPLING ERROR • CORECUT [TRUCUT] IS A TISSUE HISTOPATHOLOGY THAT IS MORE ACCURATE AND TELLS YOU ABOUT THE GRADE & INVASIVENESS; IN-SITU OR INVASIVE

  33. MAMMOGRAM MALIGNANT • 1-CALCIFICATION; CLUSTER[5-6] OF BRANCHED FINE MICROCALCIFICATION • 2-ARCHITECTURAL CHANGES; SPIKY DENSE IRREGULAR MASS BENIGN WELL DEFINED ROUNDED MASS WITH HALO SIGN; CYST,FIBROADENOMA

  34. MAMMOGRAM CONVENTIONAL & DIGITAL • IT IS NON USED FOR YOUNGER WOMEN BECAUSE THEIR DENSE BREAST TISSUE GIVES FALSE POSITIVE RESULTS • BUT IT IS GOOD FOR THE SOFT BREASTS BECAUSE THE GLANDULAR TISSUE IS SEPERATED BY FAT PLANES

  35. FIBROADENOMA ON MAMMOGRAM

  36. MRI IS THE MOST SENSITIVE 1- CAN PICK UP CARCINOMA IN-SITU 2- DIFFERENTIATES BETWEEN LOCAL RECURRENCE AND FIBROSIS

  37. MRI • NO RADIATION BUT MAGNETIC FIELD • 1-CAN VISUALIZE A PALPAPABLE MASS WHICH IS NOT SEEn ON U/S OR MAMMOGRAM • 2-CAN BE USEFUL IN YOUNG WOMEN • 3-CAN LOCATE BREAST CANCER WITH AXILLARY L.N. METS BUT BREAST FREE ON US OR MAMMOGRAM • 4-CAN DETECT MULTICENTRIC LESION • 5-CAN DIFFERENTIATE BETWEEN RECURRENCE AND FIBROUS TISSUE • 6-CAN DETECT SILICON LEAK • DISADVANTAGES • 1-CANNOT DETECT CALCIFICATIONS • UBOS:UNIDETIFIED BRIGHT OBJECTS • DISLODGE CERTAIN METALS;RACEMAKER • EXPENSIVE

  38. POSITRON EMISSION MAMMOGRAM SHOWS [MULTIFOCAL LESION]

  39. RETRACTED BREAST

  40. SWOLLEN BREAST WITH NIPPLE RETRACTION

  41. MULTIPLE LOCAL RECURRENCE CANCER EN-CUIRASSE درع المحارب

  42. LYMPHOEDEMA COMBINATION OF SURGERY &RADIOTHERAPY ON THE AXILLA CANCAUSE THIS

  43. Axillary venous thrombosis in ca. breast

  44. DIFF.DIAGNOSIS OFMASTITIS & MASTITIS CARCINOMATOSA MASTITIS CARCINOMATOSA [INFLAMMATORY CARCINOMA] • IS THE MOST MALIGNANT OF ALL BR. CA. • MASTECTOMY IS RARELY INDICATED BECAUSE IT IS LATE • NO CONSTITUTIONAL SYMPTOMS • NO FEVER • NO LEUCOCYTOSIS • SKIN OEDEMA > 1/3 OF THE BREAST • IN BOTH THE BREAST IS WARM,TENDER • BOTH OCCUR IN CHILD BEARING PERIOD • DIFFICULT TO DISTINGUISH SOMETIMES EXCEPT BY CORECUT BIOPSY. • US & MAMMOGRAM ARE USELESS BECAUSE THERE IS NO MASS

  45. DIFF.DIAGNOSIS OF PAGET`S DISEASE &ECZEMA OF THE NIPPLE PAGET`S DISEASE • THERE IS AN UNDERLYING BREAST CANCER • UNILATERAL • NIPPLE DESTRUCTION • BOUNDRIES OF THE LESION IS WELL DEMARKATED • DOES NOT RESPOND TO STEROID LOCAL THERAPY

  46. PAGET`S DISEASE OF THE BREAST

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