MASTOPATHY

Khern Ing Ying Group 11 5th year, 2nd semester

The structure of the female breast is complex including fat and connective tissue, as well as lobes, lobules, ducts and lymph nodes Each breast has 15 to 20 lobes. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk. Fat fills the spaces between lobules and ducts. There are no muscles in the breast, but muscles lie under each breast and cover the ribs.

Each breast also contains blood vessels and vessels that carry lymph.

VASCULAR ANATOMY OF THE BREAST

Arteries: Subclavian artery: - Internal thoracic artery Thoracic aorta: - Post. Intercostal arteries Axillary artery: - Thoracocromial artery -Lateral thoracic artery Venous drainage: - axillary vein

LYMPHATIC DRAINAGE
4main routes: laterally: anterior axillary nodes medially: internal thoracic nodes cutaneous nodes of the contralateral breast superiorly: apical axillary nodes medial axillary nodes inferiorly: cutaneous lymphatics of the superior abdominal wall the liver

MASTOPATHY
Mastopathy is a breast disease manifested by pathological growth of breast tissue. Mastopathy is a background disease mostly common for women in the age between 17 and 45. The main complaints include breast pains caused by neoplasm. Moreover, later the mastopathy has potential to transform into cancer.

TYPES

Diffuse

Fibrous Cystfibrous

Nodular
Fibrous Cystfibrous

DIFFUSE MASTOPATHIA
Usually in young female Location: usually on upper outer quadrant Complaints: constant pain which increase in 2nd part of menses; discharge may be present or absent Palpation: slightly firm mass in upper outer quadrant in upright position, mass decrease or unpalpable when patient is lying down

NODULAR MASTOPATHIA
Usually in elder female Complaints: constant pain which increase in 2nd part of menses; discharge may be present or absent Palpation: slightly firm mass in upper outer quadrant in upright position, mass do not decrease when patient is lying down

WHY DOES THE MASTOPATHY OCCUR?

Both men and women suffer from mastopathy The diseases is caused by hormonal dysregulations. The main reason for hormonal dysregulation: - diseases of ovaries that produce hormones -compromised liver function - infectious gynecological diseases - emotional overload and stress - interruption of pregnancy, etc. Risk factors: fat and smoked food, drinks alcohol and smokes hereditary predisposition Breast trauma

The woman can be exposed to mastopathy at any time at the very beginning of growing-up when the endocrine profile is just being established, and before menopause when endocrine profile is distorted.
The mastopathy is a misbalance of the endocrine profile that causes changes in mammary glands.

CLINICAL SYMPTOMS
breast pains / discomfort premenstrual breast engorgement in the middle of the cycle (for 2-3 days before the menstrual period is usual) lump in the breast skin changes in the breast nipple disorders - feels bulging of the nipples - sanies from the nipples

INVESTIGATION OF BREAST DISORDERS

Triple Assessment 1. Clinical Examination 2. Breast Imaging (Mammography-MLO,CC, US) 3. Biopsy (when indicated) Mammography is the most sensitive and specific imaging test currently available, though 10% to 15% of clinically evident breast cancers have no mammographic correlate. CT, MRI

TREATMENT
Non-operative or surgical. Non-operative treatment supposes drug therapy: pills, creams, herb teas. Surgical treatment supposes operative intervention and is applied in much neglected cases.

PROGNOSIS
If a women goes to the doctor in time, in 90 per cent of cases the therapeutic treatment is enough. In neglected and extreme case, it can transform into cancer or adenoid tumors. Adenoid tumors are benign nodes that can transform in cancer if neglected.

BENIGN BREAST DISORDERS

Types 1. Fibrocystic Changes Fibroadenosis 2. Fibroadenoma 3. Duct Papilloma 4. Fat Necrosis 5. Breast Infections 6. Mammary Duct Ectasia 7. Male Breast Disorders 8. Mastopathia 9. Hemangioma 10.Fibroma

1. FIBROCYSTIC CHANGES FIBROADENOSIS

It's an abnormality of normal development and involution of the breast (ANDI)

Clinical Presentation Presents either as a single lump or areas of lumpiness which are painful and tender premenstrually

!!!Fibrocystic Change can mask a cancer, both clinical and radiologically

- Most common between ages 35-45 years-old Cyst formation is more prevelant over the age of 40 and in perimenopausal women

Management Exclusion of cancer GLA (gamolenic acid) Danazol + Bromocriptine

2. FIBROADENOMA
-

small, solid, rubbery, noncancerous, harmless lumps composed of fibrous and glandular tissue, localised form of ANDI Clinical Presentation

- Most common between ages of 15-30 Single rounded mass, smooth, firm and highly mobile - Breast Mice

!!! Must be small lesions, bacause larger fribroadenomas should be distinguish from benign phylloids tumour!!!
- Multiple and Bilateral

FEW EXAMPLES

3. DUCT PAPILLOMA
Localised areas of epithelial proliferation

Clinical Presentation

- Usually occurs as solitary lesions in the main lactiferous ducts, close to the nipple - Multiple, occur more peripherally - Present as spontaneous, blood-stained or clear watery nipple discharge

MANAGEMENT

Papillomas are treated by excision of affected duct Microdochectomy or a group of ducts, wedge resection

!!! If the causative lesion can't be found on the operation, a subareolar excision of all the ducts may be necessary!!!

4. FAT NECROSIS

Clinical Manifestation can simulate carcinoma clinically and mammographically history of antecedent trauma, prior surgical intervention lipidfilled cysts

fibrosis, calcifications, egg shell on mammography

5. BREAST INFECTIONS
a. Cellulitis - diffuse inflammation of CT with severe inflammation of dermal and subcutaneous layers of the skin - Early phase is reversible if treated with antibiotics (Flucloxacillin) b. Abcess - results of inadequately treated cellulites - red, painful, tender, warm - pus formation

Infections of the breast lobules Group A Streptococcus and Staphylococcus are the most common of these bacteria

Contrast between Cellulitis and Abcess

6. DUCT ECTASIA
- Dilatation and shortening of major lactiferous ducts - Appears around menopause - Half of all women >60 years old

Clinical manifestations

- Ductal discharges ranges from creamish to blue green - Nipple retraction - Palpable mass !!! Plasma cells characteristic feature in histology Plasma cell Mastitis

Management

- Antibiotics

7.MALE BREAST DISORDERS

a. Gynecomastia - Abnormal overdevelopment of male breast

Physiological: at birth in response to maternal oestrogens crossing placenta Medication: Spironolactone, Digoxin, Isoniazid Pathological: Liver disease

b. Male cancer - 0.5-1% - More common in carriers of BRCA2

Gynecomastia vs Male Cancer