BREAST DISEASES

OUTLINE INTRODUCTION ANATOMY BREAST ANOMALIES INFLAMMATORY/ INFECTIOUS BREAST DISEASES OTHER BREAST DISORDERS/ DISEASES BENIGN TUMORS OF THE BREAST

INTRODUCTION The breast is an organ for infant feeding, pleasure and sorrow! It is the birth right of all mammals to posses breast. The breasts are in pairs; the number depends on the specie. The breast contain epithelial and connective tissue elements that secretes milk and provides support. It therefore contains fat, ducts, glands, fibrous tissue, blood vessels and lymphatics. These are potential sites of disease.

INTRODUCTION CONTD Majority of breast diseases occur in females but the male sex is not exempt. Most breast diseases in the young are benign, but with advancement of age, benign problems of the breast give way to malignant conditions. Women with benign breast lumps are apprehensive that the mass might actually turn out to be a cancer. Careful counseling supported by confirmed histological diagnosis often relieves this anxiety.

ANATOMY OF THE BREAST

ANATOMY CONTD

ANATOMY CONTD

ANATOMY CONTD

BREAST ANOMALIES Amastia Hypoplasia Polymastia Athelia Polythelia

BREAST ANOMALIES CONTD

BREAST ANOMALIES CONTD

BREAST ANOMALIES CONTD Poland’s syndrome

INFLAMMATORY/ INFECTIOUS BREAST DISEASES Lactational Mastitis The common organism is Staphylococcus aureus Delay in recognition is the rule due to associated mammary congestion Resolution is often quick but inadequate treatment could lead to chronicity

INFLAMMATORY/ INFECTIOUS BREAST DISEASES CONTD Mondor’s Disease This variant of thrombophlebitis involves the superficial veins of the anterior chest wall and breast. Rarely bilateral Presents as acute pain in the lateral aspect of the breast A tender firm cord follows the distribution of the vein Usually resolves within 4-6 weeks Treatment: Medications, warm compress, support, excision in refractory cases

Mondor’s Disease

INFLAMMATORY/ INFECTIOUS BREAST DISEASES CONTD Hidradenitis Suppurativa A chronic inflammatory condition that originates within the accessory areolar glands of Montgomery or axillary sebaceous glands Mimics Paget’s disease of the nipple, breast cancer Treatment: Antibiotic therapy, I&D, excision

GYNAECOMASTIA Refers to an enlarged breast in the male Usually bilateral, but could be unilateral Aetiology: - Physiological - Pathological Treatment: Depends on the cause

GYNAECOMASTIA CONTD

ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION(ANDI) Spectrum of breast conditions that range from normal to disorder to disease. Common between 20 and 45 years Highest incidence between 30 and 40 years Usually bilateral More common in nulliparous women Pathogenesis is uncertain but probably hypersensitivity of developing breast epithelium to circulating hormones especially estrogen.

ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION CONTD Pathologically: Adenosis, cyst formation, epitheliosis and fibrosis Clinical Features: Pain, lump(s), nipple discharge Differentials: Breast cancer, Tietze’s syndrome, Fibroadenoma

ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION CONTD

ABBERATIONS OF NORMAL DEVELOPMENT AND INVOLUTION CONTD Treatment Reassurance Topical NSAIDS Primrose oil Danazol Tamoxifen Bromocriptine Excision

BENIGN BREAST TUMORS Galactocele Fibroadenoma Traumatic fat necrosis Duct Ectasia Duct Papilloma Cystosarcoma Phyllodes Nipple Adenomas Lipoma Harmatomas

GALACTOCELE Milk- containing cyst Develops during lactation but may occur up to 6-10 months after breastfeeding according to Haagensen. Thought to be due to blockage and dilatation of the lactiferous duct Presents as painless, soft or tense, well circumscribed, flunctuant mass Diagnosis: Aspiration Treatment: Spontaneous resolution, aspiration, excision

FIBROADENOMA Constitutes 75% of all benign breast tumours An aberration of the developing terminal lobular unit due to hormones Develops during the reproductive period Composed of stromal and epithelial elements Clinical types: - Pericanalicular - Intracanalicular Subtypes: - Giant Fibroadenoma - Juvenile Fibroadenoma

FIBROADENOMA CONTD Pericanalicular Commoner than intracanalicular Occurs between 14-30years with a peak incidence between 21-25years Usually round or oval and 1-3cm in diameter

FIBROADENOMA CONTD Intracanalicular Occurs between 30-50 years Grows less slowly Usually up to about 10cm Treatment: - Reassurance - Excision

TRAUMATIC FAT NECROSIS Supposed to be traumatic in origin, a history of trauma is unobtainable in most patients May perhaps be due to micro trauma Presents as painless hard, irregular surface breast mass Mimics breast cancer Diagnosis: Histology Treatment: Excision biopsy

TRAUMATIC FAT NECROSIS

DUCT ECTASIA Commonest cause of nipple discharge Dilatation of subareolar lactiferous ducts Common between 40-50 years Presentation: Recurrent pain/ discomfort, nipple discharge, retraction, palpable mass, mammilary fistula Diagnosis: Galactography Treatment: Excision, Microdochectomy, Fistulostomy/(ectomy)

DUCT ECTASIA CONTD

DUCT PAPILLOMA Arises from the epithelium of a lactiferous duct near its termination at the nipple Can be single or multiple Multiple papillomatosis is premalignant Most common symptom is blood stained nipple discharge Diagnosis: Galactography Treatment: Excision biopsy

CYSTOSARCOMA PHYLLODES Rare variant of intracanalicular fibroadenoma Common between 35 and 50years It is rapidly growing Pathologically: Benign(60%), borderline(15%), malignant(25%) Axillary nodes are not involved Diagnosis: Histology Treatment: - Wide local excision - Total Mastectomy

CYSTOSARCOMA PHYLLODES CONTD

NIPPLE ADENOMAS This is an ulcerating lesion on the nipple. Presents as a lump in the nipple or as nipple discharge. Biopsy is required to establish the diagnosis. Treatment is wide excision. It is usually possible to save the nipple.

NIPPLE ADENOMAS

BREAST LIPOMA It is uncommon

HAMARTOMA A hamartoma is a discrete nodule that contains closely packed lobules and prominent, ectatic extralobular ducts. Uncommon, they are also known as fibroadenolipomas. On physical examination, mammography, and gross inspection, a hamartoma is indistinguishable from fibroadenoma. Excision is curative.