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-
4. 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b. Fluid withdrawn is not blood stained.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
 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. Pagets 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.
 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
 SPREAD OF BREAST
1. Local spread-CANCER
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
dorange 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.