BREAST CYSTS

Cysts of the breast occur either in the duct or in the

stroma.
DUCTS - Fibroadenosis (ANDI) Solitary/Multiple.
- Intracystic papilliferous carcinoma.
- Galactocele.
STROMA - Papillary cystadenoma.
- Phyllodes tumour.
- Colloid degeneration of carcinoma.
- Lymphatic cyst.
- Hydatid.
 BREAST CYST
INVESTIGATION-
1. Ultrasound.
2. Needle aspiration.
3. Cytological examination of aspirated fluid.
TREATMENT-
1. Aspiration- Aspiration as a mode of treatment is only
safe when
a. Cyst does not refill.
b. Fluid withdrawn is not blood stained.
c. There is no residual lump after aspiration.
d. Cytology shows no malignant cells.
 BREAST CYST
TREATMENT-
2. Excision.
If the above criteria are not fulfilled
excision biopsy must be done.
 FIBROADENOMA
• Benign tumours with epithelial elements set in fibrous tissue
stroma.
1. Pericanalicular fibroadenoma.
 Epithelial part appears as normal ductules with background of
dense fibrous tissue.
 Age – between 14 – 30.
 Usually single.
 Extremely mobile.
2. Intra canalicular fibroadenoma.
 Connective tissue stroma is less dense and projects in to the duct
system.
 Age – between 35- 50 .
 May be bilateral and are more deeply located.
 FIBROADENOMA
INVESTIGATION-
1. USG.
2. Fine needle aspiration biopsy and cytology.
TREATMENT-
Excision.
GIANT FIBROADENOMA-
 Fibroadenoma measuring more than 5cm.
 Occurs during puberty and occasionally in women
aged between 35 – 40.
 PHYLLODES TUMOUR
• Also known as serocystic disease of Brodie or
cystosarcoma phyllodes.
• Age about 40 years but may appear in younger
women.
• Large or massive tumour with uneven or
bosselated surface.
• Ulceration of the overlying skin may occur.
• Histologically shows features of fibroadenoma.
• Rarely may show sarcomatous elements.
• May metastasise via blood stream.
 PHYLLODES TUMOUR
TREATMENT-
1. Wide local excision.
2. Mastectomy.
 CARCINOMA OF THE BREAST
Most common from of cancer in females.
Commonest cause of death in middle aged
women in western world.
Incidence most in the so called developed
world than the developing countries.
Incidence more in the west then east. Japan
ranks lowest among countries with reliable
statistics.
 ETIOLOGY
a. Sex – Much more common in females then
males. There is about 1 carcinoma of breast in
men for every 100 carcinoma among women.
b. Geographical – More in the west than in the
east.
c. Genetic – Much more common in women
with family history of breast cancer than in the
general population.
 ETIOLOGY
d. Diet –
 Because of the difference of incidence in
developed and developing countries, diet is
thought to have a role.
 High intake of alcohol is associated with
increased risk.
 ETIOLOGY
e. Endocrine –
 Common in unmarried/nulliparous women.
 Having a first child at an early age has
protective action.
 common among the obese in post
menopausal women because of conversion of
steroid hormones to oestradiol in body fat.
 Role of oral contraceptive pills controversial.
 PATHOLOGY
 Arises from the epithelium of the duct system.
 Can arise any where – from the nipple end of the
major lactiferous duct to the breast lobule.
 Those arising from the ducts are called ductal
carcinoma.
 Those arising in the lobule are called lobular
carcinoma.
 Insitu carcinoma is pre-invasive cancer, which
have not breached the epithelial basement
membrane.
 HISTOLOGICAL CLASSIFICATION OF
CARCINOMA OF THE BREAST
( Foote and Stewart )
A. Paget’s disease of the nipple.
B. Carcinomas of mammary ducts - Noninfiltrating/ Infiltrating.
1. Papillary carcinoma. 2. Comedocarcinoma.
3. Carcinoma with productive fibrosis.
4. Medullary carcinoma with lymphoid infiltrate.
5. Colloid carcinoma. 6. Tubular carcinoma.
C. Carcinomas of mammary lobules.
1. Noninfiltrating. 2. Infiltrating.
D. Relatively rare carcinomas.
E. Sarcoma of the breast.
 NATURAL HISTORY
Typical carcinoma of the breast is a scirrhous
adenocarcinoma beginning in the duct and invading the
parenchyma.
 Generally starts in the upper and outer quadrant (40
– 50 %).
 Starting as a single cell, it double its volume every 2 –
9 months in 70 % of patients.
 It takes about 30 doubling time of a tumour to attain
the size of about 1 cm- the smallest clinically
palpable lump.
 At about the 20th doubling, the timing tumour attains
its own blood supply and can therefore metastasise.
 SPREAD OF BREAST CANCER
1. Local spread-
a) Other portions of the breast. b) Skin/Muscles/Chest wall.
2. Lymphatic spread-
 Primarily to the axillary group and to the internal mammary
group.
 Site of the tumour in the breast does not indicate which
nodes will be involved.
 In advanced disease there is involvement of the
supraclavicular group.
 Involvement of nodes is not a chronological event in the
evolution of breast cancer.
 Presence of gross tumour in node indicates poor host
resistance and increased chance of disseminated metastasis.
 SPREAD BY BLOOD STREAM
1. Skeletal metastasis-
Osteolytic metastasis in the lumbar vertebra,
femur, thoracic vertebra, rib and skull.
2. Metastasis to the liver, lung, brain, and
occasionally to the adrenal glands and ovary.
 CLINICAL FEATURES
 Incidence of breast carcinoma shows a increase
after the age of 25 years. At the age of 90 years,
20 % women are affected (western statistic).
 Disease presents as a hard lump in the breast,
commonly in the outer and upper quadrant.
 In drawing of the nipple may be present.
 Local spread to the skin may present with peau
d’orange or even frank ulceration.
 About 20% of cases in the developing world
present with metastatic disease.
 FEATURES RESULTING FROM
LYMPHATIC OBSTRUCTIONS
1. Peau d’ orange- Carcinoma cells infiltrate and
block the lymphatics of the skin causing
lymphatic oedema. Where the skin is
tethered by sweat glands, it cannot swell,
leading to an orange peel appearance.
2. Cancer en-cuirasse- Skin over the chest wall
is infiltrated with carcinoma, and becomes
thick and hard and has been linked to a coat.
 FEATURES RESULTING FROM
LYMPHATIC OBSTRUCTIONS
3. Late oedema of the arm- is a complication of
radical axillary dissection and appears any time
from months and years of treatment.
Recurrence should be excluded.
4. Lymphangio-sarcoma- is a late complication
of lymph oedema and may occur after many
years.