Benign Breast Mass

1. Manzano, Clairol  Marcelo, Pamela Marcial, Karmi Margaret  Matematico, Michelle Matias, Evangelyn  Maulion, Marienelle Benign Breast Mass

2. Three females with ages 23, 35, and 55 years, respectively, went to see you for consult. All have a mass in one of their breasts.

3. What important general data from the patients do you think are important to be able to guide you in your diagnosis? Explain. • Breast Lump • Age • Family History • Reproduction and Menstrual History • Radiation Exposure • Hormone Replacement Therapy • Oral Contraceptives • Body Mass Index

4. Breast Lump • Time of recognition • Number • Size • Changes before menstruation • Location • Shape • Borders • Mobility • Tenderness • Pain

5. Risk Factors •  Age =  Breast Cancer risk • Family History • Relative Risk of Cancer: 1st degree > 2nd degree Sister > Mother Highest risk: (+) FH – Mother and Sister • Early Menarche & Late Menopause •  Breast Cancer risk • Nulligravidity is a risk •  Radiation Exposure =  Breast Cancer risk • HRT, Contraceptives, Obesity •  Estrogen Exposure =  Breast Cancer risk

6. Physical Examination: Benign vs. Malignant Lesion

7. How will you approach the 23-year old, with a 2 X 2 X 2cm, firm, mobile, well-circumscribed non-tender mass on her L breast?

8. Diagnosis • FIBROADENOMA • Benign fibroepithelial neoplasm from the terminal duct lobular unit of the breast • Painless, firm, solitary, mobile • Occurs in young women of child bearing years • (20 to 30 years old) • Size: 2 – 3 cm • Borders: Well-defined • Margins: Regular • NOT PREMALIGNANT

9. Role of Imaging Modalities • Mammography • Indeterminate Mass with suspicion of cancer • Pre-requisite prior BCT • Follow-up after BCT and of contralateral breast • Ultrasound • Distinguish between solid and cystic masses • Provide guidance for cyst aspiration or core biopsy • For palpable mass that is partially or poorly seen on a mammogram

10. Management • Fine Needle Aspiration Biopsy • Below 25 years old: OBSERVATION • 25 to 35 years old: OBSERVATION/EXCISION • Above 35 years old: EXCISION • Follow up: PE and Mammography • Cryoablation Treatment • Alternative to open surgical removal of fibroadenoma

11. How will you approach the 35-year old, with a 2 x 2 x 2cm, firm, mobile, well-circumscribed non-tender mass on her R breast?

12. Approach to the Patient • History • Physical Examination • Bilateral Mammography • Fine Needle Aspiration Biopsy • Cytology

13. Role of Imaging Modality

14. A mammogram was taken as seen in the picture. Is this benign or malignant?

15. Radiologically: Benign vs. Malignant Lesion

16. Should the patient have a mother who is a breast cancer survivor, how would that information change your management

17. How will you approach the 55-year old menopausal patient with a 2-cm diameter, mobile, firm, non-tender mass on her R breast?

18. Role of imaging modality

19. Diagnosis

20. FNAC reveals NEGATIVE FOR MALIGNANT CELLS. How would you now manage the patient?

21. A 43-year old female consults because of a rapidly growing L breast. Axilla is negative for clinically palpable nodes.

22. Differential Diagnosis

23. Histopathology

24. Final Diagnosis

25. Pathophysiology

26. Treatment

27. A 55-year old female consults because of bloody nipple discharge.

28. Differentiate a physiologic from pathologic nipple discharge.

29. Describe how you would localize the involved duct.

30. Diagnosis and Treatment

31. Two ladies aged 20 and 48 years, respectively, consulted because of bilateral breast tenderness.

32. In the 20-year old, what is your foremost consideration?

33. In the 48-year old, what is your foremost consideration?

34. How do you differentiate the diagnosis in #1 from that of #2?

35. How will you manage the 20-year old?

36. The 48-year old undergoes surgery showing the gross finding below, What is your treatment?