Common Breast Diseases

byPROF/ GOUDA ELLABBAN

SCU HOSPIAL/ EGYPT

Congenital

• Extra nipples and Breast- • polythalia, polymazia• Milk line• Unilateral hypoplasia- augmentation• Hypoplasia of pectoral muscles

Life cycle of Breast

• Development – early reproductive• Mature reproductive life• Involution• Most BBD occur in specific period –

aberrations – rather than disease• Changes in glandular tissue- areas of

fibrosis, microcysts, adenosis

<25 yrs

• Normal Development- aberration

• Stromal - juvenile hypertrophy• Lobular – Fibroadenoma

• ANDI- abberations of normal development and involution

25-40 yrs

• Cyclical activity

• cyclical mastalgia • cyclical nodularity- focal, diffuse

35-55 yrs

• Normal• Involution• Lobular – macrocysts• Stromal – sclerosing lesions• Ductal -- duct ectasia

Juvenile Hypertrophy

• Uncontrolled growth• Adolescent girls• No endocrine abnormality• Social embarrassment, pain, discomfort• Reduction mammoplasty

Fibroadenoma

• Develop from whole lobule• Mass in breast• Types – FA, Giant FA,Juvenile FA,

Phyllodes tumor• Giant - > 5cm diameter• CBE, USG,FNA• 2yrs – 10% in size, rest disappear

Pain , nodularity

• Physiological, prolonged – aberration• Focal nodularity – common- all ages• Pathological – benign breast changes

Involution

• Palpable breast cysts- perimenopausal• Smooth lump,painful• MMG,USG, FNA - blood + , cytology• Re-examine breast – MMG,USG,FNA – 1-

3% Ca, risk x2

Sclerosis

• Sclerosing adenosis,• radial scars, • complex sclerosing lesions• Excision biopsy- suspicious on MMG

Duct Ectasia

• Subareolar ducts dilate- shorten• Age 70 – 40% have duct dilation,ectasia• D/C cheesy, nipple retraction, mass• Slit like nipple,• Surgery- troublesome D/C, inverted nipple

Epithelial hyperplasia

• Terminal duct lobule unit – cellular hyperplasia

• Mild,moderate, florid• Atypia- ADH- BBD- increased risk of Br Ca• First degree relative – Br Ca

Gynecomazia

• Benign, reversible, puberty, old age• Surgery – if socially unacceptable• Senescent Gynecomazia- 50-80,males• Progressive,painless increase• MMG – fat or malignancy, FNA,hormone• Drug –anabolic steroids, - Danazol,Tmx

Benign Neoplasms

• Duct pailloma –single, multiple• Blood stained d/c, ductography• Duct excision

• Lipomas - Soft, lobulated, radioluscent• Haematomas – trauma – RTA. FNA, core

bx, open biopsy• Antocoagulant therapy• Sometimes associated with Ca• Fat necrosis – Traumatic –seat belt injury• Granuloma –multiple masses, sarcoid, TB• Breast infections, Mastalgia

Infections

• Abscess- lactational-I&D,TB, syphilis,fungal• Periareolar(NL) – AB- abscess – duct fistula• Mammary duct fistula – excision• Skin infections- hidradenitis,cellulitis,

eczema, sebaceous cysts