Lecture of benign breast diseases

2021-03-19 12:00 AM

Unnourished breast discharge can have the following causes: breast cancer, duct papilloma, duct dilatation or fibrosis or oral contraceptives.

General perception

Common breast diseases in gynaecological detection and treatment are often late. If a woman discovers it herself and gets treatment early, the results are good. Small tumors less than 2 meters in diameter can be self-detect. There are two types of breast diseases: benign breast diseases and breast cancer.

General anatomy

Breast mass

About 200-300cm3 is located in front of chest from ribs 2 to ribs 6, from the sternum to the anterior axillary line including from outside to:

Skin: a small nipple in the middle, surrounded by a dark areola, a conical breast consisting of a solid connective rib, a system of elastic and smooth muscles arranged in a spiral pattern, has many tactile corpuscles and sebaceous glands. There are 10-20 openings on the nipple surface with ducts.

Fat layer: behind the layer, filling the inter-rib pits, forming the Duret grease pits.

Affiliate organization consists of two parts

Excreted part: vesicles made up of mass, secretory, astrocytes surrounded by astrocytes also known as highly contractile epithelium, each with a basal membrane, a capillary system, and connected to a small branch of the ducts.

Milk duct: ducts with small branches from the pouches into a main branch that create the ducts, which end with small holes in the face of the nipple, around the branches and ducts. have epithelial and smooth muscles. Normally, each breast has 10-20 lobes divided into bags containing bags.

Blood vessels - nerves - lymphatic vessels

The arteries that nourish the breast include:

Arterial branches under the skin.

The anterior artery branches.

The posterior artery branches.

The mammary artery branches are characterized by intricate networks divided in layers between the inner and outer mammary artery.

The venous system appears similar to the arterial system. During pregnancy, the breast vein system connects clearly under the skin, around the areola forming Haller vein ring.

Lymphatic: the lymphatic vessels of the outside of the breast pour into the axillary fossa, the inner lymphatic vessels enter the inner mammary glands.

Axillary fossa: the most important ganglia consist of 5 chains:

The lymphatic chains of the axillary veins run along the blood vessels.

The chain of the outer mammary glands is located on the chest wall.

The shoulder ganglia runs along the blood vessels of the lower shoulder.

Central ganglia located on the path of the 2 intercostal nerve branch.

Banana under the beam: extremely important in the management of breast cancer.

Nerve

Anterior breast group: includes the anterior branches of the connective nerve 2,3,4,5.

Breast group: 4.5 intercostal nerve.

The upper branch of the breast goes from the descends of the gluteus plexus.

Benign breast diseases are divided into the following groups: breast pain, fibroids, mammary gland cysts, breast secretions, breast abscesses and lactation disorders, benign breast tumors.

Breast pain

Common in women with an unstable nerve state.

May be cyclical or non-cyclical, patients typically have a feeling of heaviness and fullness in the breast during the week before menstruation and disappear after menstruation, which is considered periodic breast pain. Non-cyclical breast pain may be associated with glandular dilatation that can be detected with a mammogram.

Fat necrosis

Commonly followed by trauma or biopsy injury can cause hardening and is often accompanied by tugging. A biopsy must rule out breast cancer. Treatment must extract the block.

Treatment of nipple pain: for unknown and endocrine reasons, the direction of treatment is: pain relief and endocrine drugs such as danasol, tamoxifen 100mg X 2 tablets / day, progesterone 10mg (TB) from day 12 period.

Progestogen ointment applied to the breast from the 12th to 25th day of your period.

Fibro-adenias (fibro-adenias)

A localized or diffuse, soft-density tumor, found in women of the reproductive or premenopausal age group.

Causes: hormonal imbalance of estrogen, progestron, prolactin.

Organizational aspects include glandular fibrosis and follicular-forming mammary epithelial hyperplasia.

Diagnosis: based on palpation of soft masses appearing in the second half of the menstrual period, the outer half of the breast and possibly both breasts. Smoking to find cancer cells, biopsy, mammography to eliminate malignant lesions.

Treatment: According to the theory, methylxanthin stimulates the release of catecholamine, it stimulates the cyclic adeno monophosphate (AMP) system in the breast.

Mono found that if methylxanthine was completely abstained (coffee, tea, and chocolate), the disease was much reduced compared to the control group.

Vitamin E 600 UI / day.

The mechanism of action is to adjust the ratio of estradiol / progesterone.

Cystic disease

Common in the age group 30-50 is related to endocrine. Cysts are usually individual, mobile, tensile density. Puncture of the cyst will show a yellow-green or brown color. If the suction is blood, a biopsy is required after aspiration. If the cyst recurs after suction, it must be re-aspirated and if the tumor persists, biopsy therapy: aspiration and endocrine use as danazol.

Nipple discharge

Breast discharge in the non-nursing period can have the following causes: breast cancer, ductal papilloma, duct dilatation or fibrosis or oral contraceptives, lactation is often associated with amenorrhea, amenorrhea. ovulation is usually caused by elevated prolactin.

Clinical examination should pay attention to the points

Exudate: clear, bloody, or of a different color.

Are discharge accompanied by tumors?

There is one or more rays?

Translated continuously or in batches, naturally, must be squeezed?

Are discharge related to menstruation?

Exudate before menopause or after menopause?

Are you taking birth control pills or taking estrogen?

Differential diagnosis

The secretion from a gland often mixed with blood is usually caused by the papilloma or less commonly, breast cancer, so it must be the cell to detect cancer. If fluid is accompanied by a tumor, a biopsy is required.

Distinguishing from multiple lactation due to increased prolactin of the pituitary gland or oral contraceptives, the discharge is pus found in the abscess around the areola.

Treatment: if the discharge is not accompanied by a tumor, monthly monitoring, mammography to determine the damage

Breast abscess

Meet at or outside of child rearing.

Bacteria enter the breast when feeding through nipple openings, at an early stage, manifestations of swelling, redness, pain, antibiotics can be used or infrared, if the inflammatory block has pus localized must be cited.

Abnormal breasts

May be seen in atrophic, underdeveloped or enlarged mammary glands. Need plastic surgery.

Fibroid adenoma (fibroadenoma)

As a sheath tumor, common in the childbearing age from 15-25 years old. May grow from one side or two sides. Characteristics of the kernel are hard, mobile and have different sizes of small and large.

Pathogenesis: There are two types of fibroadenoma around the tubule or in the tubule. If the nucleus develops from within the tubule, the size is large and stretched. In pregnancy, the fibrosis causes more hormonal effects.

Phyloid tumor: is a type of fibroid tumor with a fast-growing buffer layer, easy to recur if the location is not radical. Phyloid u are rarely malignant.

Treatment: remove the tumor, but because the tumor is large, avoid recurrence should remove the breast.