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BREAST LUMP. Abdul.Kader WEISS M.D CHIRURGIE GENERALE ET VISCERALE /CHIRURGIE COELIOSCOPIQUE D.E.S, A.F.S,A.F.S.A, DU / FRANCE Reference Surgery at a.

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Presentation on theme: "BREAST LUMP. Abdul.Kader WEISS M.D CHIRURGIE GENERALE ET VISCERALE /CHIRURGIE COELIOSCOPIQUE D.E.S, A.F.S,A.F.S.A, DU / FRANCE Reference Surgery at a."— Presentation transcript:

1 BREAST LUMP

2 Abdul.Kader WEISS M.D CHIRURGIE GENERALE ET VISCERALE /CHIRURGIE COELIOSCOPIQUE D.E.S, A.F.S,A.F.S.A, DU / FRANCE Reference Surgery at a Glance 2ed Anatomy at a Glance Schwartz's Principles of Surgery, Ninth Edition

3 DEFINITION

4 ANY PALPABLE MASS IN THE BREAST

5 ENLARGEMENT OF THE WHOLE BREAST CAN OCCUR EITHER UNI- OR BILATERALLY

6 BUT

7 THIS IS NOT STRICTLY A BREAST LUMP

8 ANATOMY

9 SPECIALIZED SKIN GLANDS

10 SPECIALIZED SKIN GLANDS COMPRISING

11 FAT

12 SPECIALIZED SKIN GLANDS COMPRISING FAT GLANDULAR

13 SPECIALIZED SKIN GLANDS COMPRISING FAT GLANDULAR AND CONNECTIVE TISSUE

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16 BLOOD SUPPLY

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18 VENOUS DRAINAGE

19 CORRESPONDS TO THE ARTERIAL SUPPLY

20 LYMPHATIC DRAINAGE

21 THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS

22 A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS

23 THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns

24 THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns

25 THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns D - THE CENTRAL GROUP, 3-4 L.Ns, EMBEDDED IN THE FAT OF THE AXILLA

26 THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns D - THE CENTRAL GROUP, 3-4 L.Ns, EMBEDDED IN THE FAT OF THE AXILLA E - THE SUBCLAVICULAR GROUP (APICAL ), 6-12 L.Ns

27 THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS B - THE EXTERNAL MAMMARY GROUP (ANTERIOR GROUP), 5-6 L.Ns C - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns D - THE CENTRAL GROUP, 3-4 L.Ns, EMBEDDED IN THE FAT OF THE AXILLA E - THE SUBCLAVICULAR GROUP (APICAL ), 6-12 L.Ns F - THE INTERPECTORAL GROUP (ROTTER'S NODES), 1-4 L.Ns

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29 LYMPHATIC PATHWAYS OF THE BREAST

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31 LEFT BREAST

32 LYMPHATIC PATHWAYS OF THE BREAST LEFT BREAST ARROWS INDICATE THE DIRECTION OF LYMPH FLOW

33 THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE

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35 Lymph nodes located lateral to or below the lower border of the pectoralis minor muscle are referred to as LEVEL I LYMPH NODES which include the axillary vein, external mammary, and scapular groups.

36 THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE Lymph nodes located superficial or deep to the pectoralis minor muscle are referred to as LEVEL II LYMPH NODES which include the central and interpectoral groups.

37 THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE Lymph nodes located medial to or above the upper border of the pectoralis minor muscle are referred to as LEVEL III LYMPH NODES which consist of the subclavicular group

38 THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE

39 TOPOGRAPHY

40

41 BREAST LUMP

42 KEY POINTS

43 BREAST LUMP KEY POINTS The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease.

44 BREAST LUMP KEY POINTS The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease. The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts.

45 BREAST LUMP KEY POINTS The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease. The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts. Pain is more characteristic of infection/inflammation than tumours.

46 BREAST LUMP KEY POINTS The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease. The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts. Pain is more characteristic of infection/inflammation than tumours. Skin/chest wall tethering is more characteristic of tumours than benign disease.

47 BREAST LUMP KEY POINTS The commonest breast lumps occurring under the age of 35 years are fibroadenomas and fibrocystic disease. The commonest breast lumps occurring over the age of 50 years are carcinomas and cysts. Pain is more characteristic of infection/inflammation than tumours. Skin/chest wall tethering is more characteristic of tumours than benign disease. Multiple lesions are usually benign (cysts or fibrocystic disease).

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66 DIFFERENTIAL DIAGNOSIS

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68 WHOLE

69 DIFFERENTIAL DIAGNOSIS WHOLELOCALIZED

70 DIFFERENTIAL DIAGNOSIS WHOLELOCALIZED BEHIND

71 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL

72 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL PREGNANCY

73 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL PREGNANCY LACTATION

74 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL PREGNANCY LACTATION IDIOPATHIC HYPERTROPHY

75 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL PREGNANCY LACTATION IDIOPATHIC HYPERTROPHY DRUG INDUCED

76 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL PREGNANCY LACTATION IDIOPATHIC HYPERTROPHY DRUG INDUCED (E.G. STILBOESTROL, CIMETIDINE)

77 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL PREGNANCY LACTATION IDIOPATHIC HYPERTROPHY DRUG INDUCED (E.G. STILBOESTROL, CIMETIDINE) ENLARGEMENT IN THE N.B

78 SWELLING OF THE WHOLE BREAST BILATERALUNILATERAL PREGNANCY LACTATION IDIOPATHIC HYPERTROPHY DRUG INDUCED (E.G. STILBOESTROL, CIMETIDINE) ENLARGEMENT IN THE N.B PUBERTY

79 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS

80 LOCALIZED SWELLINGS IN THE BREAST

81 MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset

82 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus.

83 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS

84 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents.

85 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender.

86 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS

87 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE:

88 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile.

89 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile. FAT NECROSIS: irregular, ill defined, hard, ?skin tethering.

90 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile. FAT NECROSIS: irregular, ill defined, hard, ?skin tethering. LIPOMA: well defined, soft, non-tender, fairly mobile.

91 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile. FAT NECROSIS: irregular, ill defined, hard, ?skin tethering. LIPOMA: well defined, soft, non-tender, fairly mobile. CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant).

92 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile. FAT NECROSIS: irregular, ill defined, hard, ?skin tethering. LIPOMA: well defined, soft, non-tender, fairly mobile. CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant). MALIGNANT INCLUDE:

93 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile. FAT NECROSIS: irregular, ill defined, hard, ?skin tethering. LIPOMA: well defined, soft, non-tender, fairly mobile. CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant). MALIGNANT INCLUDE: CARCINOMA

94 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile. FAT NECROSIS: irregular, ill defined, hard, ?skin tethering. LIPOMA: well defined, soft, non-tender, fairly mobile. CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant). MALIGNANT INCLUDE: CARCINOMA EARLY : ill defined, hard, irregular, skin tethering

95 LOCALIZED SWELLINGS IN THE BREAST MASTITIS/BREAST ABSCESS DURING LACTATION:RED, hot, tender lump, systemic upset TUBERCULOUS ABSCESS: chronic, cold, recurrent, discharging sinus. CYSTS GALACTOCELE: commoner postpartum, tender but not inflamed, milky contents. FIBROCYSTIC DISEASE: irregular, ill defined, often tender. SOLID LUMPS BENIGN INCLUDE: FIBROADENOMA: discrete, firm, well defined, regular, highly mobile. FAT NECROSIS: irregular, ill defined, hard, ?skin tethering. LIPOMA: well defined, soft, non-tender, fairly mobile. CYSTOSARCOMA PHYLLOIDES: wide surgical excision (10% are malignant). MALIGNANT INCLUDE: CARCINOMA EARLY : ill defined, hard, irregular, skin tethering LATE : spreading fixity, ulceration, fungation, peau dorange.

96 SWELLINGS BEHIND THE BREAST

97 RIB DEFORMITIES

98 SWELLINGS BEHIND THE BREAST RIB DEFORMITIES CHONDROMA

99 SWELLINGS BEHIND THE BREAST RIB DEFORMITIES CHONDROMA COSTOCHONDRITIS (TIETZES DISEASE)

100 KEY INVESTIGATIONS

101 FNAC

102 KEY INVESTIGATIONS FNAC Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis

103 KEY INVESTIGATIONS FNAC Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis

104 KEY INVESTIGATIONS FNAC Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis ULTRASOUND Fibroadenoma, cysts, tumours (best for young women/ dense breasts)

105 KEY INVESTIGATIONS FNAC Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis ULTRASOUND Fibroadenoma, cysts, tumours (best for young women/ dense breasts) MAMMOGRAPHY

106 KEY INVESTIGATIONS FNAC Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis ULTRASOUND Fibroadenoma, cysts, tumours (best for young women/ dense breasts) MAMMOGRAPHY Tumours, cysts, fibrocystic disease, fat necrosis.

107 KEY INVESTIGATIONS FNAC Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis ULTRASOUND Fibroadenoma, cysts, tumours (best for young women/ dense breasts) MAMMOGRAPHY Tumours, cysts, fibrocystic disease, fat necrosis. BIOPSY (TRUCUT/OPEN SURGICAL)

108 KEY INVESTIGATIONS FNAC Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis ULTRASOUND Fibroadenoma, cysts, tumours (best for young women/ dense breasts) MAMMOGRAPHY Tumours, cysts, fibrocystic disease, fat necrosis. BIOPSY (TRUCUT/OPEN SURGICAL) Usually provides definitive histology (may be radiologically guided if lump is small or impalpable-detected by mammography as part of breast screening programme

109 EXAMINATION OF THE BREAST

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111 A. Inspection of the breast with arms at sides. EXAMINATION OF THE BREAST

112 A. Inspection of the breast with arms at sides. B. Inspection of the breast with arms raised. EXAMINATION OF THE BREAST

113 A. Inspection of the breast with arms at sides. B. Inspection of the breast with arms raised. C. Palpation of the breast with the patient supine. EXAMINATION OF THE BREAST

114 A. Inspection of the breast with arms at sides. B. Inspection of the breast with arms raised. C. Palpation of the breast with the patient supine. D. Palpation of the axilla. EXAMINATION OF THE BREAST

115 DUCTOGRAM

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117 BREAST CYST ECHOGRAPHY

118 BREAST CYST ECHOGRAPHY

119 MAMMOGRAPHY

120

121 THANK YOU

122 Abdul.Kader WEISS M.D 2010

123 THANK YOU Abdul.Kader WEISS M.D 2010


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