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BREAST LUMP
BREAST LUMP
Abdul.Kader WEISS M.DCHIRURGIE 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 GlanceSchwartz's Principles of Surgery, Ninth Edition
DEFINITION
DEFINITION
ANY PALPABLE MASS IN THE BREAST
ENLARGEMENT OF THE WHOLE BREAST CANOCCUR EITHER UNI- OR BILATERALLY
BUT
THIS IS NOT STRICTLY A BREAST LUMP
ANATOMY
SPECIALIZED SKIN GLANDS
SPECIALIZED SKIN GLANDSCOMPRISING
SPECIALIZED SKIN GLANDSCOMPRISING
FAT
SPECIALIZED SKIN GLANDSCOMPRISING
FATGLANDULAR
SPECIALIZED SKIN GLANDSCOMPRISING
FATGLANDULAR
AND CONNECTIVE TISSUE
BLOOD SUPPLY
VENOUS DRAINAGE
VENOUS DRAINAGECORRESPONDS TO THE ARTERIAL SUPPLY
LYMPHATIC DRAINAGE
THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
THE SIX AXILLARY LYMPH NODE GROUPS RECOGNIZED BY SURGEONS
A - THE AXILLARY VEIN GROUP (LATERAL), 4-6 L.NS
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
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.NsC - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.Ns
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.NsC - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.NsD - THE CENTRAL GROUP, 3-4 L.Ns , EMBEDDED IN THE FAT OF THE
AXILLA
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.NsC - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.NsD - THE CENTRAL GROUP, 3-4 L.Ns , EMBEDDED IN THE FAT OF THE
AXILLA E - THE SUBCLAVICULAR GROUP (APICAL ), 6-12 L.Ns
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.NsC - THE SCAPULAR GROUP (POSTERIOR OR SUBSCAPULAR), 5-7 L.NsD - 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
LYMPHATIC PATHWAYS OF THE BREAST
LYMPHATIC PATHWAYS OF THE BREAST
LYMPHATIC PATHWAYS OF THE BREAST
LEFT BREAST
LYMPHATIC PATHWAYS OF THE BREAST
LEFT BREAST
ARROWS INDICATE THE DIRECTION OF LYMPH FLOW
THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE
THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE
THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE
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.
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.
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
THE LYMPH NODE GROUPS LEVELS ACCORDING TO THEIR ANATOMIC RELATIONSHIP TO THE PECTORALIS MINOR MUSCLE
TOPOGRAPHY
TOPOGRAPHY
BREAST LUMP
BREAST LUMP
KEY POINTS
BREAST LUMP
KEY POINTS• The commonest breast lumps occurring under the age of 35
years are fibroadenomas and fibrocystic disease.
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.
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.
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.
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).
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
WHOLE
DIFFERENTIAL DIAGNOSIS
WHOLE LOCALIZED
DIFFERENTIAL DIAGNOSIS
WHOLE LOCALIZED
BEHIND
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
PREGNANCY
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
PREGNANCYLACTATION
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
PREGNANCYLACTATIONIDIOPATHIC HYPERTROPHY
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
PREGNANCYLACTATIONIDIOPATHIC HYPERTROPHY
DRUG INDUCED
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
PREGNANCYLACTATIONIDIOPATHIC HYPERTROPHY
DRUG INDUCED (E.G. STILBOESTROL, CIMETIDINE)
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
PREGNANCYLACTATIONIDIOPATHIC HYPERTROPHY
DRUG INDUCED (E.G. STILBOESTROL, CIMETIDINE)
ENLARGEMENT IN THE N.B
SWELLING OF THE WHOLE BREASTBILATERAL UNILATERAL
PREGNANCYLACTATIONIDIOPATHIC HYPERTROPHY
DRUG INDUCED (E.G. STILBOESTROL, CIMETIDINE)
ENLARGEMENT IN THE N.B
PUBERTY
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/BREAST ABSCESS
LOCALIZED SWELLINGS IN THE BREAST
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/BREAST ABSCESS• DURING LACTATION:RED, hot, tender lump, systemic upset
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/BREAST ABSCESS• DURING LACTATION:RED, hot, tender lump, systemic upset• TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/BREAST ABSCESS• DURING LACTATION:RED, hot, tender lump, systemic upset• TUBERCULOUS ABSCESS: chronic, ‘cold’, recurrent, discharging sinus.
CYSTS
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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.
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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.
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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:
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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.
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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.
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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.
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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).
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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:
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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
LOCALIZED SWELLINGS IN THE BREASTMASTITIS/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 d’orange’.
SWELLINGS BEHIND THE BREAST
SWELLINGS BEHIND THE BREAST
RIB DEFORMITIES
SWELLINGS BEHIND THE BREAST
RIB DEFORMITIES CHONDROMA
SWELLINGS BEHIND THE BREAST
RIB DEFORMITIES CHONDROMA
COSTOCHONDRITIS (TIETZE’S DISEASE)
KEY INVESTIGATIONS
KEY INVESTIGATIONS FNAC
KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUNDFibroadenoma, cysts, tumours (best for young women/ dense breasts)
KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUNDFibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHY
KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUNDFibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHYTumours, cysts, fibrocystic disease, fat necrosis.
KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUNDFibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHYTumours, cysts, fibrocystic disease, fat necrosis.
BIOPSY (‘TRUCUT’/OPEN SURGICAL)
KEY INVESTIGATIONS FNAC
Tumours, fibroadenoma, fibrocystic disease, fat necrosis,mastitis
ULTRASOUNDFibroadenoma, cysts, tumours (best for young women/ dense breasts)
MAMMOGRAPHYTumours, 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
EXAMINATION OF THE BREAST
EXAMINATION OF THE BREAST
A. Inspection of the breast with arms at sides.
EXAMINATION OF THE BREAST
A. Inspection of the breast with arms at sides.B. Inspection of the breast with arms raised.
EXAMINATION OF THE BREAST
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
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
DUCTOGRAM
DUCTOGRAM
BREAST CYSTECHOGRAPHY
BREAST CYSTECHOGRAPHY
MAMMOGRAPHY
MAMMOGRAPHY
THANK YOU
THANK YOUAbdul.Kader WEISS M.D 2010
THANK YOUAbdul.Kader WEISS M.D 2010
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