Fibroadenoma
Most common tumor of breast
Age
15-25 yr
Nature?
Benign
(Part of ANDI..hyperplasia of single
lobule)
Size
Small….usually <2cm
If >5cm…giant fibroadenoma
Slow progression
Less
Smooth, firm, painless, nontender,
well localized,
Duration
Recurrence
Clinical
features
freely movable swelling in one of
the quadrants (mouse of the
breast)
Axillary LAP
Mammo
US
Cytology
Treatment
No
Macroscopically (soft, hard type)
Microscopically
(intracanalicular..large soft,
pericanalicular..small hard)
Phylloid tumor (Cystosarcoma)
Not simply giant fibroadenoma
Phyllodes…leaf like (on microscopy)
Older (40-50)
pre-menopausal women (30-50)
Wide spectrum of activity
Almost benign (85%)
Locally aggressive & sometimes
metastatic (15%)…to lung/bond
Large, bosselated
Rapid growth
Common
Smooth, soft, fluctuant, nontender
Skin changes
skin necrosis, streching, and redness
and dilated veins over it
usually unilateral,
Tumor is warmer, not fixed to skin or
chest wall, nipple retraction is absent.
usually no
Grossly, it is large capsulated area with
cystic spaces and cut surface shows soft
, brownish cystic areas.
Microscopically (cystic spaces with
leaf like projections)
Same findings
Send for CXR, CT chest in phyllodes
Excision
Excision/ subcutaneous mastectomy
If malignant (sarcoma)…total mastectomy
Cyclical mastalgia (2 thirds)
30-50 yr
It is linked to the menstrual cycle, increasing
in severity in the days preceding menstruation
and then decreasing after the onset of menses
Bilateral
Aching pain or heaviness affecting the upper
outer quadrants of the breast.
Non cyclical mastalgia (1 third)
More common in older & pPost menopausal
women
Localized breast pathology
large cysts in fibrocystic disease
periductal mastitis
engorgement during lactation
breast abscess
Unilateral
Sharp burning or localized pain in one quadrant
Extra-Mammary (non breast) pain
arises from the chest wall or other sources and its interpreted as a cause within the breast like
Mondors disease and Tietz syndrome (Costochondritis)
Pain
Vomiting
Periodicity
Complications
Gastric ulcer
After meal
Aggravated by eating
Relieved by fasting
More (due to pyloric spasm)
Green, sore
No known/less periodicity
Bleeding is less common but
dangerous (from main
arteries..left gastric/ splenic
artery)
Hematemesis is more (pyloric
spasm)
Duodenal ulcer
Hunger pain
Aggravated by fasting
Relieved by eating
Yellow, bitter
More
(Symptoms more prominent in
certain time of year)
Most commonly from posterior
DU (gastroduodenal artery)
Melena is more