3. Case 1
• Madam Z, 40 y/o presented with multiple lumps
at right breast that associated with cyclical pain.
PE revealed soft and fluctuated lumps.
• Fibroadenosis/fibrocystic disease
• Triple assessment
• Reassurance, cyst aspiration, hormone
manipulation e.g. COC pill
3
5. • If aspirated fluid is blood stained or cyst recur
many times core biopsy or local excision
• Exclude cystadenocarcinoma
5
6. Case 2
• Miss Y, 22 y/o presented with a small painless
mobile lump at right breast that not increased in
size. She is otherwise well. PE revealed fixed, firm,
well defined margin, freely mobile breast lump.
• Fibroademona
• Triple assessment
• Treatment depends on its size
<3 cm: reassurance
>3 cm: excision
6
8. 8
Ultrasonogram demonstrates a
hypoechoic mass, well defined margin
Craniocaudal mammograms
demonstrate a mass in the outer part
of the breast
http://emedicine.medscape.com/article/345779-overview
2 cm
9. Giant fibroadenoma
9
Ultrasound images of the left breast in a 15 y/o girl
show a large (the mass measured 8.2 cms.), hypoechoic
and well defined mass
http://www.ultrasound-images.com/breast.htm
10. • Occasionally during puberty
• >5 cm in diameter
• Rapidly growing
• Excision
• Potential for malignancy is low
10
Povoski World Journal of Surgical
Oncology 2007 5:124
http://www.indianpediatrics.net/jan2005/jan-72.htm
Enlarged right breast due to
fibroadenoma
11. Case 3
• Miss X, 48 y/o admitted with small breast lump
had been present over many years and had
started to enlarge in the last 3 months. The lump
is mobile.
• She was single and nulliparous but without a
family history of breast cancer
11
12. 12
• Right breast showing a large
fleshy tumour protruding from
the lower outer quadrant with
most of the remaining breast
also containing tumour.
• The surrounding skin
although bluish is not
oedematous
• A large heterogeneous mass of 5.6 x 3.4
cm with multiple lobulations and cystic
spaces also present.
• The appearance of the tumour was leaf
like in its internal architecture
http://casereports.bmj.com
13. • Diagnosis:
Phyllodes tumor
▫ Rare breast tumor that forms from the connective
tissue of the breast.
▫ Benign, malignant or borderline by histological
▫ Surgical removal
Benign:- removing the mass and a 2 cm area of
normal breast tissue from around the tumor.
Malignant:- removed with a wider margin of breast
tissue or by total mastectomy if needed
13
Tumor
14. Traumatic fat necrosis
▫ Fibrosis
▫ Local hematoma/bruising
▫ Calcification
• New, painless/painful breast lump
• Poorly defined margin lump
• History of trauma
• Triple assessment
• Resolved spontaneously, excision biopsy
14
http://www.makemeheal.com
15. Summary
15
P. Youssefi, et al. Mind Maps in Surgery
Benign breast disease
(part 1)
• Middle age, > 40 y/o
• Slow growing, smooth, large, big enough to
cause skin necrosis, unevenly surface
• Potentially malignant
• Rx : surgical removal
Phyllodes tumor
16. Other references:
1. Bailey & Love’s Short Practice of Surgery 25th edition
2. Oxford Handbook of Clinical Surgery 3rd edition
16
Editor's Notes
Hx: size not change
*more common in last decade of reproductive age
Mammogram: generalized hyperintensity & maybe no lesion seen, http://radiopaedia.org/images/879835
Histopathology (not practice): there may be microcysts, fibrosis, adenosis of hyperplastic changes of the breast epithelial tissue
Histology: well marked capsule, hyperplasia tissue
*slowly growing
Mammogram was performed on the patient and a large lobulated mass in was noted
Histology with haematoxylin eosin stains revealed leaf-like architecture, long clefts with marked stromal overgrowth and hypercellularity.
Locally invasive, recur or distant mets
Not respond to hormonal, chemo/radiotherapy
Ref: www.mypacs.net/cases/PHYLLODES-TUMOR-1512497.html
