Breast
Hend almalki
Station 1
a young lactating female she gave a history of 24 hr
tenderness and redness
a) The pic. show ??
b) the causative organism is ?
c) DDx ?
d ) list 2 Rx ?
e) the affected parts r ??? nipple
& the areola ???!!
a- what dose the picture show?
Swelling ,redness, pus discharge of the breast
B- what is the causative organism?
Staphylococcus aureus
C- what is the differential diagnosis?
Breast abscess proceeded by early phase acute mastitis
D- what is the treatment?
Antibiotic (dicloxacillin)needle aspiration with culture
taken and if large abscess incision and drainage should be
done
E- what are the affected parts?
Breast lobule will be affected via the nipple ,duct system
and circulation
Station 2
A- name the abnormality that you see
in the picture?
B- what is your DDx?
c- what is the 1st underlying structure
that will concern us if it get attached
to this lesion?
D- what maneuver that done to make
this lesion more clear ?
E- list the groups of axillary Lymph
node?
f- what is the different between benign
and malignant breast cancer?
A- name the abnormality that you see in the picture?
Skin dimpling caused by tethering
note :puckering is multiple dimpling of the skin(this note is from
doc kurdi session)
B- what is your Dx?
Breast cancer
c- what is the 1st underlying structure that will concern us if it
get attached to this lesion?
The fibrous septa (cooper`s ligament) that separate breast
lobule which may block the lymphatic that run alongside them
causing edema of the breast and peau d` orange apperance
D- what maneuver that done to make this lesion more clear ?
Ask the patient to raise the hand above the head
E- list the groups of axillary Lymph node?
There are six groups can be easily remembered by the acronym
'APICAL' -anterior, posterior,infraclavicular, central,apical
and lateral :
1- anterior or medial (pectoral)
2- posterior or inferior (subscapular)
3- lateral ( humeral)
4-(central) or intermediate ( they drain from ant , post and lat then
efferents drain into apical)
5- ( infraclavicular or subclavicular)
6-( apical) : the final group , receives its afferents from all other
groups and from the
mammary tail and its efferents form the
subclavian trunk.
That was the anatomical classification
Surgically, axillary lymph nodes r classified into 3 levels going from
lateral to medial in relation to pectoralis minor p.m. muscle: level 1 :
lat to p.m. ( mainly ant , post & lat groups) , level 2 : behind p.m.
Mainly ( central and some apical nodes) , level 3 : medial to p.m. (
mainly infraclavicular group+ some apical )
f- what is the different between benign and malignant breast cancer?
Malignant
Benign
Anywhere
Commonly in the axillary tail
presnted as smooth, rubbery,
discrete, well-circumscibed brest
mass, non-tender, mobile,
hormone dependent
Solid mass ,painless , roughly spherical
breast mass, fixed , not mobile
Age <40
Age > 40
none
Nipple(discharge, rash , retraction)
skin dimpling,edema
Axillary ,supraclavicular lymph node
-Mammogram
- US
- FNA to R/O solid lesion
Triple assement (history &
examination, imaging:
mammogram-US,pathology)
Metastatic screen(chest,liver,bone
,brain)
Benign
Generally conservative – serial
observation
-Excision if:
mass rapidly growing,
if >5cm in size
or if Pt. wants
Malignant
Stage I,II
BCS ( breast conservative surgery):
Lumpectomy with free margin
+radiation
+/- Axillary clearance (ALND)
+/- chemotherapy
If there is any contraindication of
conservative as to radiation (skin
excoriation , pregnancy , CTD )we go
for non conservative
Stage III, IV
Modified radical mastectomy (MRM
Simple mastectomy (it’s MRM without
LN dissection)
+Chemotherapy
Nowadays all breast cancer pt receive
chemotherapy except for pt who
can`t tolerate it as old women who
can die by post chemo infection we
give her tamoxifen if ER receptor
+ve
Benign
Malignant
Circumscribed mass
Spiculated mass
Fat-containing lesion
Architectural distortion with no history
of prior surgery
Macrocalcifications :Widely scattered
Microcalcifications (<0.5 mm) :Tightly
clustered
Round, uniform density, large, coarse
Linear, branching, pleomorphic, casting
Long axis of the lesion is along the
normal tissue planes
Lesion is taller than it is wide
Homogeneous internal echotexture
Decreased hyperechogenicity
Hyperechogenicity
Marked acoustical shadowing
Smoothly marginated
Spiculation
Station 3
*describe what u see.?
*Dx?
*give 3D.Dx for bloody
discharge from nipple?
A- describe what you see?
Retracted nipple
b- what is your differential diagnosis?
Congenital retraction, duct ectasia, carcinoma
C- give3 differential diagnosis for bloody
discharge from nipple?
Intraductal Carcinoma ,Intraductal papilloma
Paget’s disease
Station 4
Q. describe
Q. mention 3 important points that you should ask
about in the Hx (risk factors) ?
Q. what is the most proper diagnosis ?
A- describe what you see?
Bilateral breast enlargement
b- mention 3 important points that you should ask about in the Hx
(risk factors) ?
*Drugs(antihistamine ,cimetidine , anabolic steroid, diuretics
spironolactone,estrogen for prostatic cancer ,digoxin
decreased testosterone)
sign and symptoms of
* liver cirrhosis or
* bronchial carcinoma
D -what is the most proper diagnosis ?
gynaecomastia
NB
Common Breast Lumps:
Young Women: Fibroadenoma / Abscess
Pregnant : Galactocoele / abscess
Middle aged and elderly women: Cancer higher up the differential diagnosis
list.
Galactocele:
a cystic tumour containing milk or a milky substance
Galactocele is usually round and freely mobile
Needle aspiration is the choice for diagnosis and treatment with large gauge
needle as the content of a galactocele is thick and creamy
Surgery is performed when needle aspiration is not possible or when it
becomes infected.
Thank you