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BREAST

BREAST. Begashaw M (MD). Introduction. Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions  discomfort  confusion with neoplastic disease. Anatomy.

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BREAST

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  1. BREAST Begashaw M (MD)

  2. Introduction Modified sweat gland - produces milk Breast ca - most common cause of death Benign conditions  discomfort confusion with neoplasticdisease

  3. Anatomy overly -2nd – 6th rib- from lateral border of sternum to anterior axillary line, between clavicle & to the 7th & 8thribs below Ligaments of cooper Areolacontains involuntary muscles nipple covered by thick skin lactiferous ducts Lymphatics -axillarylymph nodes on the ipsilateral side

  4. Anatomy

  5. Breast lumps • DDx • Cancer • Fibrocystic change • Fibroadenoma • Fat necrosis • Duct ectasia • lipoma •TB

  6. Breast cyst Rare due to a nonintegrated involution of stroma& epithelium often multiple & may be bilateral Diagnosis –aspiration/ultrasound Treatment – Aspiraton

  7. Fibroadenoma • Most common in women age < 30 • C/F Nodulessmooth, rubbery, discrete, well-circumscribed, non-tender, mobile • Ixs -biopsy -ultrasound -FNA • Treatment _Generally conservative: serial observation _Consider excision if size 2-3 cm & rapidly growing

  8. Fibroadenoama

  9. Phyllodes Tumor _Are benign tumors _Usually occur in women over 40 years _large, massive tumor with unevenly lobulated surface and occasionally with ulceration of overlying skin _Treatment – Enucleation _ Simple mastectomy

  10. PhyllodesTumour

  11. Ductectasia/ periductal mastitis is dilatation of breast ducts associated with periductalinflammation Pathogenesis _ Dilatation of lactiferous ducts  filled with a stagnant brown or green secretiondischarge _irritant reaction in surrounding tissue leading to periductalmastitis

  12. Clinical presentation -Nipple discharge -subareolar mass -Abscess -Mammary duct fistula/nipple retraction • Treatment -Excision of all major ducts

  13. Investigation of a Breast Lump

  14. Acute mastitis • is acute inflammation of the breast • Bacterial mastitis is the commonest variety of mastitis and nearly always commences acutely • associated with lactation Causestaphylococcusaureus • Clinical presentation - Pain - Swelling • Redness • Tenderness/hotness • abscess

  15. Treatment • Antibiotics – cloxacillin • Breast restbreast-feeding on the opposite side only • Support breast • Local Heat/Analgesics

  16. Breast abscess If acute infection of breast doesn’t resolve with in 48 hours/tense induration Abscess Fluctuation is a late sign When doubt exists  incision & drainage Treatment – incision & drainage

  17. Lactational breast abscess Nonlactational breast abscess

  18. Breast abscess drainage

  19. Breast Carcinoma is the commonest cause of death in middle-aged women in western countries In our set up, increasing incidence is being observed

  20. Risk Factors _ Gender -99% Female _ Age80% >40 years old _ Prior hx of breast ca _1st degree relative _ Nulliparity, First pregnancy >30 years old, Menarche < 12 yrs old, Menopause >55 yrs old _Decreased risk with lactation,Earlymenopause, Early childbirth _Radiation exposure _Obesity,Diet,Geography-western

  21. Pathology Arise from the epithelium of the duct system May be entirely in situ or may be invasive Grades -Well differentiated -Moderately -Poorly differentiated Ductal carcinoma -Most common Lobular carcinoma -10 %

  22. Breast cancer Locally advanced breast carcinoma

  23. Nipple retraction

  24. Spread • Localspread: increases in size & invades,involveskin,penetrate pectoral muscles& chest wall • Lymphatic spread _Axillarylymph node _Supraclavicularnodes _Contra lateral lymph nodes • HematogenousBone(lumbar,Femur, thoracic vertebra, rib/skull) osteolytic) liver, lungs & brain

  25. Clinical presentation • occurs commonly upper outer quadrant/UOQ • Local Findings _Hard, irregular lump _nipple retraction _Skin involvement with peau d’ orange _Frank ulceration &fixation to the chest wall

  26. Signs and Symptoms Most common: lump or thickening in breast. Often painless Discharge or bleeding Redness or pitting of skin over the breast, like the skin of an orange Change in size or contours of breast Change in color or appearance of areola

  27. Signs of metastasis _Lymph node enlargement _Bone pain _cough • Chest x-ray, Serum alkaline phosphates & liver ultrasound

  28. Prognosis - Tumor size & LN status - Invasive & metastatic potential - Histological grade - Estrogen receptor status • Patient age

  29. Treatment • Multi disciplinary _Surgery _Radiotherapy _Medical therapy -Chemotherapy -Hormonal therapy

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