Содержание
- 2. Anatomy of the Breast
- 3. Position & extent Extends from the 2nd to the 6th rib & from the lateral margin
- 4. Structure of the Breast The lobule is the basic structural unit of the mammary gland.The number
- 5. The ligaments of Cooper are hollow conical projections of fibrous tissue filled with breast tissue; the
- 7. The ligaments of Cooper
- 8. Blood supply
- 9. Internal thoracic”mammary” artery – perforating branches Axillary artery – Lateral thoracic artery ”mainly” Superior thoracic artery
- 10. Venous drainage Sub areolar venous plexus Posterior intercostal veins communicate with internal vertebral venous plexus veins
- 11. • Cutaneous innervation • Medial pectoral nerve • Lateral pectoral nerve • Long thoracic nerve Nerves
- 12. The lymphatics of the breast drain predominantly into the axillary and internal mammary lymph nodes. The
- 17. Physiology of the Breast
- 18. GROWTH HORMONE , PROLACTIN , ADRENAL GLUCOCORTICOIDS , INSULIN
- 20. Hypothalamic-hypophysial Portal system Growth hormone , Parathyriod hormone, cortisol insulin
- 22. The breast glands and ducts begin to shrink and disappear. Connective tissue supporting the glands becomes
- 23. Benign Breast Disease
- 24. Benign Breast Disease The most common cause of breast problems. 30% of women will suffer from
- 25. Benign breast disease Benign conditions of the nipple. Aberrations of normal development & involution. Fibroadenomas &
- 26. Conditions of the nipple 1-Nipple retraction
- 27. Conditions of the nipple 2- supernumerary nipples
- 28. Conditions of the nipple 3- cracked nipple : forerunner of infective mastitis
- 29. Conditions of the nipple 4-papilloma of the nipple 5-retention cyst 6-eczema (should be distinguished from paget’s
- 31. 7- Nipple discharge
- 33. Aberrations of normal development & involution
- 34. Aberrations of normal development & involution Cyst formation Fibrosis Hyperplasia Papillomatosis
- 35. ANDI Breast cysts
- 36. Fibroadenomas & Phyllodes Tumor:
- 37. Acute and Subacute Inflammations of the Breast:
- 38. 1- Bacterial mastitis & breast abscess:
- 39. 2- Mondor’s disease: ? Should be distinguished from Lymphangitis caused by cancer.
- 40. 3- Duct ectasia/periductal mastitis: Nipple Discharge. Periductal Mastitis. Abscess. Fistula. Nipple retraction. mass.
- 42. Injuries to the Breast: 1- Haematoma. 2-Traumatic fat necrosis.
- 43. Congenital Abnormalities:
- 44. 1- Amazia & polymazia:
- 45. 2- Mastitis of infants:
- 46. 3- Diffuse hypertrophy:
- 47. Malignant diseases CARCINOMA OF THE BREAST
- 48. Breast cancer is the second most common cancer with nearly 1.7 million new cases in 2012.
- 49. Aetiological factors Geographical… Age… Gender… Genetic… Diet… Endocrine… Previous radiation…
- 50. Pathogenesis Genetic factor… Hormonal factor… Enviromental factor…
- 51. Histopathologic classification Ductal ------ Lobular Invasive ------ In situ
- 52. Breast carcinoma in situ
- 53. Ductal carcinoma in situ (DCIS)
- 54. Lobular carcinoma in situ (LCIS)
- 55. In situ carcinoma is pre-invasive cancer. Becoming increasingly common. At least 20% of patients will develop
- 56. Treatment Surgical excision Mastectomy? Partial mastectomy with safety margins > 1cm Radiotherapy?
- 57. Invasive breast carcinoma
- 58. Invasive Ductal carcinoma (IDC)
- 59. Invasive Lobular carcinoma (ILC)
- 60. Other rarer variants Colloid (mucinous) carcinoma: produce abundant mucin. Medullary carcinoma: solid sheets of large cells
- 61. Inflammatory breast cancer
- 62. Rare, highly aggressive cancer that presents as a painful, swollen breast, which is warm with cutaneous
- 63. Paget Disease of the Nipple
- 64. It is a superficial manifestation of an underlying breast carcinoma (IDC or DCIS). Presents as an
- 65. The spread of breast cancer Local spread… Lymphatic metastasis… Hematogenous spread…
- 66. Phenomena resulting from lymphatic obstruction in advanced breast cancer:
- 67. Peau d’orange
- 68. Cancer-en-cuirasse
- 69. Lymphangiosarcoma
- 71. Breast Carcinoma Grading The degree of differentiation: Well differentiated. Moderately differentiated. Poorly differentiated.
- 72. Breast cancer staging TNM staging takes into account: The size of the tumour (T). Whether the
- 75. Skeletal isotope bone scan showing multiple ‘hot-spots’ due to metastases.
- 76. Prognosis of breast cancer The best indicators of likely prognosis in breast cancer remain tumour size,
- 79. Breast Cancer in Men Breast Cancer in Men accounts for less than 1% of male cancers
- 80. Screening & Imaging Breast screening aims to find breast cancers early. It uses an X-ray test
- 82. Early Detection Plan
- 83. Screening Protocol
- 84. Mammography Soft tissue radiographs are taken by placing the breast in direct contact with ultrasensitive film
- 85. Mammography (Cont’d)
- 86. Ultrasonography Ultrasound is particularly useful in young women with dense breasts in whom mammograms are difficult
- 87. Ultrasonography (Cont’d)
- 88. Magnetic Resonance Imaging Magnetic resonance imaging (MRI) is of increasing interest to breast surgeons in a
- 89. Magnetic Resonance Imaging (Cont’d) Magnetic resonance imaging scan of the breasts showing carcinoma of the left
- 90. History:
- 91. PRESENTATION OF BREAST DISEASE Breast disease presents in three main ways: lump, which may or may
- 92. Breast lump (Mass) When did the patient first notice it & how? Site Painful or not
- 93. Breast pain Duration SOCRATES Relation with periods Nipple discharge Discoloration and hotness of skin Fever, fatigue,
- 94. Nipple Discharge Site (nipple itself or adjacent area) Episodic or continuous Color Viscosity Passive or induced
- 95. Skin changes Skin dimple Eczema Indrawing of the skin Ulceration Discoloration Redness and hotness Overall swelling
- 96. Nipple changes Is it retracted or destroyed Uni/bilateral Can it be everted easily
- 97. Gynecological symptoms : Last menstrual cycle duration menarche menopause Any changes: Increased blood, clots or irregularity
- 98. Past History (e.g breast cyst) Drug History (e.g oral contraceptives, hormone replacement therapy) Family History (
- 99. Physical Examination:
- 100. Position Inspection Palpation
- 101. position The patient must be fully undressed to the waist. sitting 45 degrees Patients sometimes say
- 102. Inspection Stand or sit directly in front of the patient, inspect both breasts and look for
- 103. 4. Nipples & Areolae: Depression Destruction Discoloration Displacement Deviation Discharge
- 104. To check for accessory nipple: check the nipple line ( axilla-->groin), if the nipple is inverted
- 105. (Supraclavicular fossa) Ectopic breast tissue in the anterior axillary fold Visible LN in arm, axilla and
- 106. B) Arms Over Head : Skin changes (esp. tethering) are more prominent, and to expose the
- 107. PALPATION Ask the patient to lay down with her hand ipsilateral to the breast. Ask where
- 108. The breast should be palpated with the flat of the fingers and not with the palm
- 109. * If there is a lump we should analyze it : Lump Site Size Shape Edge
- 110. Relations of the lump to skin
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