Benign Breast Disease July 12, 2007
description
Transcript of Benign Breast Disease July 12, 2007
Benign Breast Disease
July 12, 2007
Maggie Gordon, R2
Benign Breast Disease
Breast Anatomy
A – ducts B – lobules C – lactiferous sinus D – nipple E – fat F – pectoralis major G – ribs and intercostal
muscles
A – duct cells B – basement membrane C – duct lumen
Benign Breast Disease
By Diagnosis
Risk Factors
Estrogen replacement Genetic changes
Acquired Congenital, including BRCA1, BRCA2
Protective Anti-estrogens, e.g. Tamoxifen
Fibrocystic Change
Normal variant 60% of pre-menopausal women ↑ cysts or fibrous tissue in otherwise normal
breast Types
Hyperplasia – 20’s Adenosis – 30’s Cystic disease – 30’s-40’s
Fibrocystic Disease
Fibrocystic change w/ severe pain nipple discharge excessive lumpiness → suspicion of cancer
Cause = blockage / dilation of ducts
Duct Ectasia
Distension of ducts Contain crystalline material Can develop localized infection May leave nodule after resolution
Solitary Papillomas
Arise from cyst Present with sanguinous / sero-sanguinous
discharge
Fibroadenoma
Benign solid tumours Present as well-defined, mobile masses ↑ with estrogen, pregnancy 2-23% prevalence in adolescents to mid-20’s
Others
Superficial thrombophlebitis of the thoracoepigastric vein (Mondor's disease)
Mastitis, breast abscess, granuloma Galactocele Fat necrosis (panniculitis) Hamartoma Lipoma Neurofibroma Squamous, apocrine metaplasia Tubular adenoma Sarcoidosis Diabetic mastopathy
Benign Breast Disease
By Symptoms
Breast Pain
Normal cyclic breast pain Fibrocystic change Fibrocystic disease, when severe Mastitis Large, pendulous breasts
Cooper’s ligaments stretching Occasionally
Masses, including malignancy Duct ectasia Hidradenitis suppurativa
Nipple Discharge
Spontaneous, bloody, unilateral: malignancy Provoked, non-bloody, bilateral: benign Milky
Post-partum ↓ thyroid Pituitary tumour → prolactin Meds
OCP TCA’s
Nipple Discharge
Sticky Cystic changes Duct ectasia
Breast Mass
Mostly fibroadenoma ≥90% palpable breast masses 20’s to early
50’s are benign
Must exclude malignancy
Benign Breast Disease
Investigation
History
Physical Exam
Palpation of Mass
“Classic” findings in malignancy Single lesion Hard Immovable Irregular border Skin dimpling over lesion Size ≥2cm
Imaging
Mammography ≥35y.o.
Ultrasound <35y.o. Dense breasts
May be omitted in women who have lactational nipple discharge or cyclic breast pain as long as there is no breast mass
Biopsy
Essentially any solid mass
Benign Breast Disease
Treatment
Fibrocystic Change
Reassurance Support with appropriate bra Acetaminophen, NSAID’s Cysts can be aspirated May help
↓ fat, caffeine, nicotine Vit E, evening primrose oil
Tamoxifen, danazol ↓ medical estrogen
Simple Fibroadenoma
Several options Follow with US Core bx, then nothing further
Surgical excision not recommended Up-and-coming: US-guided cryoablation
Cyst
Aspiration Bloody fluid → cytology Non-bloody fluid → garbage
Follow-up US No recurrence → no further intervention Recurrence → surgical consult