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ANDI: ABERRATION OF NORMAL DEVELOPMENT & INVOLUTION

PATHOGENESIS: Arise on the basis of dynamic changes in breast thru 3 main periods of reproductive life
< 25
25-40
> 40

BREAST
DEVELOPMENT
CYCLIC ACTIVITY
INVOLUTION

STROMAL
LOBULAR

Juvenile hypertrophy, 1ry Gynecomastia


Fibroadenoma
Cyclical mastalgia, Cyclical nodularity
Sclerosing lesion
Cysts
Ductal hyperplasia, Duct ectasia

STROMAL
LOBULAR
DUCTAL

FIBROADENOMA
1. FIBROADENOMA SIMPLEX (CLASSIC/HARD
FA)

CLASSIFI
-CATION

CHARACTER: Well capsulated, solid, rubbery,


round/oval, non-tender, smooth freely mobile
BREAST MOUSE
SIZE: Rare grow > 2-3 cm
PROGRESSION: 80% static, 15% regressive,
10% progressive

CLASSIFICATION

CYCLIC MASTALGIA

CYCLIC NODULARITY
(FIBROADENOSIS)

DEF: Breast pain related to menstrual cycle

1. GENERALIZED NODULARITY

ETIO: Hormonal imbalance, water retention,


neurosis, decreased essential fatty acid (Lenolenic
acid/GLA)

2. FOCAL NODULARITY
Common cause of breast lump up to age 50
PATHOLOGY: Localized fibrosis, adenosis,
microcysts

1. TRIPLE ASSESSMENT
2. CLINICAL EXAMINATION
3. ULTRASOUND +/- MAMMOGRAPHY

If age > 35y/o


4. BIOPSY

1. TRIPLE ASSESSMENT
2. CLINICAL EXAMINATION
3. ULTRASOUND +/- MAMMOGRAPHY

If age > 35y/o


4. BIOPSY

If BIRAD 4/5 on U/S or mammography

2. FIBROADENOMA COMPLEX

CHARACTER: Show cysts, sclerosing adenosis,


epithelial calcification/ papilary apocrine changes
3. GIANT FIBROADENOMA (SOFT FA)

1.

CHARACTER: Soft
SIZE: > 5 cm
Shoud do biopsy to differentiate with PHYLLODES
BREAST U/S

Round/oval shape, weak internal echoic

Not indicated under 35 y/o

If atypical or suspicious

2. MAMMOGRAPHY
DIAGNOS
IS

MANAGE
-MENT

3. NEEDLE BIOPSY
Core biopsy better than FNA
1. REASSURANCE & FOLLOW UP with careful
monitoring by U/S
2. SURGERY
Indication: Size > 3 & giant FA, age > 40y/o, atypical or

1.
2.

If BIRAD 4/5 on U/S or mammography

REASSURANCE & RECORD PAIN for at least


3 months
GENERAL MEASURES: Proper fitting bra,

GENERALIZED NODULARITY: Reassurance


FOCAL NODULARITY: Reassurance, excision

needle biopsy not conclusive, complex FA, phyllodes


tumor

BREAST CYSTS
1. MICROCYSTS

FEATUR
ES

Degeneration of acini
(lobules)
Usually simple & multiple
SITE: Affect whole breast/ a
sector
2. MACROCYSTS

Retention cysts from ductal


obstruction by
hyperplasia/fibrosis
Maybe solitary/multiple
Maybe simple or complex

U/S

DUCTAL HYPERPLASIA

DUCTAL ECTASIA

PATHOLOGY

PATHOLOGY

Increase no of cell layer lining the


terminal duct lobular unit (TDLU)

TYPES
1. TYPICAL HYPERPLASIA
Mild: 2-4 rows
Moderate: 4-8 rows
Florid: > 8 rows

Proliferation of small
breast ductules (TDLU)
with fibrosis
Complex sclerosing
lesion associated with
significant amount of
epithelial hyperplasia

CP: Mass or mastalgia


RISK OF MALIGNANCY :
2x

2. ATYPICAL HYPERPLASIA
<2 mm in diameter
strong interaction between
atypia & F/H of breast
cancer

Duct dilate & shorten


Filled with inspissated
(thick) fatty materials
Minimal periductal
inflammation

3.
4.

If blood-stain fluid or
residual mass

F/U after 3 6 weeks


Reaccumulate for 3rd time
= EXCISION
GALACTOCELE

Consist of more than 2


element:
a.
b.
c.
d.

Cyclic nodularity
Sclerosis
Cysts
Ductal hyperplasia

RISK OF MALIGNANCY
5x & 10x with F/H of breast cancer
TRIPLE ASSESSMENT
CP: Lump, nipple discharge,
screen detected
2. MAMMO: Archetectural
distortion, microcalcification
3. BIOPSY: FNAC
TYPICAL HYPERPLASIA: F/U

Excision biopsy

ATYPICAL
a.

MACROCYSTS
1. Aspiration with 21g needle
2. Cytology

FIBROCYSTIC
CHANGES

CP
Age: 40 y
Nipple discharge:
Bloody, cheesy, creamy,
sticky, thick, green (all
at 1 time)
Slit-like nipple retraction
Mass

Triple assessment

1.

Ddx

biopsy

PATHOLOGY

Triple assessment

SIMPLE CYST
1. F/U by sono-mammography
2. Palpable > 2 cm =
Aspiration
MANAG
E-MENT

reduce caffeine intake


DRUGS: GLA, Tamoxifen/LHRH,
Bromocriptine, Danazol

SCLEROSIS

RISK OF MALIGNANCY:
1.5x with complex cysts, 3x with
F/H
DIAGNO
-SIS

3.

b.

No F/H -> Wide local excision


+ clinical & mammographic
surveillance
+ve F/H -> Prophylactic SC
mastectomy + immediate
reconstruction

* remove all breast except nipple &


areola

1. CONSERVATIVE
Anti-inflammatory,
corticosteroid
2. NIPPLE DISCHARGE
Total duct excision (Hadfield
Op)
3.

MASS : Excision

Late > 6 w no respond to


medical ttt + troublesome
nipple discharge
Excision

ETIO: Retention cysts due to


blockage of a milk duct
CP: Near-areola cyst, milk
extrude on pressure
TTT: Spontaneous regression
after weaning or excision