Spectrum of Benign Breast Disease and Its Management

Spectrum of gracious Breast Disease and Its Man developmentAUTHORSDr.( Mrs) Archana shukla (Assistant professor )dept of surgery Gandhi medical college, Bhopal M.P.Dr. S. S. Pal (Associated professor) dept of surgery Gandhi medical college Bhopal M.P.ABSRACT Breast disorder in females causes slap-up deal of anxiousness and fear of carcinoma and thus losing it. non all told boob complaints and lumps argon carcinoma. To exact this enigma of females, longanimouss with breast symptoms were analyse for 12 months of time Jan 2013 to Dec 2013 in unit iii, dept of surgery, Hamidia hospital, Gandhi medical college Bhopal. piece of work was conducted to determine the relative incidence, role of histopathology and imaging in diagnosing and management. The disease is tortuous separate of symptoms and sign such as lump, mastalgia, pablum discharge and conspiracy of these. This was do so as to differentiate and identify the favorable sort which was much larger in number. They re quire much counseling, assurance and program line regarding benign nature and it being a growingal disorder. such(prenominal) disorders if un hard-boiled whitethorn convert into disease which is more persistent.The mean age was 32 as the youngest was age of 14 yrs and the oldest was of 50 yrs of age. The reciprocalest diagnosis was fibroadenoma geted by fibroadenosis . terabit was the most(prenominal) c erstrning disease we came across.KEYWORDS Benign Breast Diseases, young female, fibroadenoma.INTRODUCTION legal age of affected roles having sign and symptoms of breast disease fall under benign mathematical group rather than carcinoma yet carcinoma takes the precedence over it receivable to its fearsome nature.1,2,3,4 The benign breast disease group patients dumb put variable symptoms including lump, lump with torture, nodularity, pap discharge due to relative heterogeneous underlying pathology.5Breast development is governed by growth horm mavin and cortisol. Breast function is governed by oestrogen progesterone prolactine and oxytocin. Breast undergoes dynamic cyclic changes governed by these hormones and growth factors. 15 These hormones drive home profound trophic effect. These changes argon seen in epithelium and stroma from onset of puberty to menopause. Estrogen have effect on ducts where as progesterone have effect on epithelium. With the onset of puberty thither is decrease in sensitivity of the hypothalamus and pituitary axis to negative feedback and increased sensitivity to constructive feedback of estrogens. This initiates GnRH, FSH, LH causing increase in estrogens and progesterone which is the cause for catamenial cycle. This increase is responsible for proliferation of epithelium, duct and stroma. These changes may egest to Aberration in normal development of breast and involution of breast, causing majority of benign breast disorder. These disorders may convert into disease if untreated.Exaggerated response to hormones oestro gen causes development of single or multiple proliferatory breast diseases such as fibroadnenoma which is benign solid mobile mass which has both fibrous and glandular part.11 Fibroadenoma of more than 10 cm atomic number 18 termed as phylloids tumor owe to shape it attains due to large size.Sometimes the changes have proliferation of ducts, lobules, laylobular and inter lobular stroma leading to fibrous changes with cystic changes comm all termed fibrocystic disease. 13Such proliferation may have atypical hyperplasia including ductal and lobular hyperplasia, which has increased risk for development of carcinoma in future. Apart from this, multi central lesions with calcification increase m whatever fold risk.6,7.8Then thither are symptoms of nipple. As a developmental defect at that place may be nipple inversion which may present as subareolar abscess in later age. During involution phase there is ductal involution causing ductal ectasis if non treated can lead to periductal m astitis or may sometimes have atypical hyperplasia.6During lactation the breast undergoes many dynamic changes and if there is problem in expression of milk there may be occurrence of breast abscess. If not treated adequately may lead to chronic breast abscess, antibioma and milk sinus.To certain the diagnosis of usually unheeded and unde simplicityimated disease there is a huge role of histopathology and imaging technologies.With the back up of histopathology proliferatory , non proliferatory disorders and diseases, breast cyst and other pathologies such as tuberculosis and adipose tumor can be detected. 20 in that respect is a role of microbic culture in diagnosis of infectious disease. Similarly ultrasonography is cooperative in diagnosis and in management withal.13,22Triple assessment test, which admit clinical examination imaging and histopathology examination is the gold standard advent to the diagnosis though elderly females may require mammography.20,21,22We have con ducted study to determine the frequency of the disease, to analyze the role of triple assessment and to get it on implication in management. 13,15 16METHODOur study was conducted for one socio-economic class in Jan 2013 to Dec 2013, under unit 3 Dept. of Surgery, Hamidia Hospital, Gandhi Medical College. We include all the patients coming to surgery OPD with breast complaints.14 Informed consent was obtained from all the patients. patient ofs were recorded under go alonging pointsHistory, Clinical examinationFNAC of all unmistakable lumps, nodularities was through with(p). In patients where there was dilemma trucut biopsy was through. Microbial examination and abscess wall biopsy was done in all case of breast abscess and antibiomas.USG, mammography Imaging was done. In our setup, USG was the most accessible radiographic investigation available. All the patients were subjected to USG to locate and know the lesion except in doubtful cases mammosonography was done.Age varied fr om 12-50 years hence 4 groups were made12-20 years20-30 years30 -40 years40 and in a exalteder placeRESULTIn first age group the most roughhewn complaint was lump in one of the breast or both. or so of these patients did not have complaints of paroxysm. It was followed by lump with pain. We did not have any patients with complaint of nipple discharge in this group.15,16,17In second group most common complaint was lump in breast with pain and symmetrical generalized breast pain without lump and nodularity which were grouped under mastalgia.The third group was less(prenominal)er in number. They were mainly having complaints of lump, fever and pain. There were real few patients in fourth group and complaints were that of pain and nipple discharge.In total there were 148 patients with lump and out of which 62 were that of fibroadenoma, 4 patients of fibroadenoma were of size more than 10 cm hence labelled as phylloid. Most of the fibroadenoma were unilateral and only 7 patients h ad bilateral adenomas. 5,12There were 40 patients who were diagnosed as fibroadenosis. All patients underwent FNAC one patient showed atypical hyperplasia. 6,7,8After this, the succeeding(a) common diagnosis was that of breast abscess which was common in lactating females.The diagnosis which worried us the most was that of tuberculosis of breast. We found 10 cases of this disease presenting as chronic and recurrent breast abscess, showed mycobacterium tuberculi in culture.18 We also found 6 patients of antibioma and 2 patients of galactocoele. There were patients of ductal ectasia and one patient of lipoma and one of breast cyst.Patients having significant symptoms of pain only not found with any lesion on radiographic investigation were labeled as mastalgia. Out of 7 only 3 were cyclical and rest were not related to cycle. 15,16,17MANAGEMENT- Out of 62 patients of fibroadenoma, there were 18 patients with lesion less than 2 cm as detected clinically and confirmed by ultrasonograp hy .these patients were treated conservatively.22 Surgery was proposed to all other 44 patients 40 patients consented for surgery and were operated, in all these excision was done under anesthesia.12We registered 40 patients of fibroadenosis, in 6 patients excision of the most painful and noduler force field was done rest of the patients were treated conservatively by oral medication of evening prime rose oil and vitamin E. In patients not getting meliorate by above, Danazol which is an anti gonadotrophin was found useful. As it is having androgenic effectuate non compliance was observed in most of the patients. In one patient with FNAC showing atypical hyperplasia excision of affect quadrant with subsequent fulfil was done by series of mammography. As patient with atypical hyperplasia, multi focal lesion with calcifications have many fold increased risk for developing carcinoma 6,7,8 Patient was subjected risk reduction strategies like yearly mammography, stopping oral birth control device pills and hormone replacement therapy if any.6,7In patients with mastalgia cyclic or non cyclic patients are treated with conservative elan by life style modification, have low fat diet and avoiding caffeine. After ruling out transmitting pt responds well to NSAID and Danazol.Simple breast cyst was treated with aspiration.22All 12 the patients of breast abscess were treated by surgical ID. microbic examinations were done all the cases.21,2310 patients came history of presence of lump and pain and low grade fever and malaise, on ultrasonography showed hypo onomatopoetic lesion suggestive of abscess showed presence of mycobacterium tuberculi in abscess wall biopsy and were treated by anti tubercular treatment.18Patient with antibioma were treated in conservative manner in lactating women where as in non lactating open waste pipe and curettage was done.There were two patients of galactocoele and one of breast cyst in which aspiration was done.One patient of breast lump after excision biopsy was diagnosed as lipoma.All the patients with complaints of nipple discharge underwent cytological examination of action fluid. There was one patient of ductal ectasia which on ultra sonogrphy showed ductal pappiloma for which microdochectomy was done.Patients with bilateral breast pain with cyclic nodularity were diagnosed as mastalgia. These patients underwent series of ultrasonography only if no focal lesion was found. In patients with mastalgia cyclic or non cyclic patients are treated with conservative manner by life style modification, eating low fat diet and avoiding caffeine. Patient responds well to NSAID and Danazol. interventionWhen a female notices breast lesion she undergoes great degree of anxiety due to apprehension of gruesome carcinoma which causes breast lose and most fearful disfigurement.1.3.4 Benign breast diseases are much more common than malignant lesions but the aggressive nature of carcinoma takes the precedence of the worry.9 Thus it the most important precession of surgeon to reach up to a definite diagnosis and once the carcinoma is excluded the patient should be reassured and educated for further follow up.10,23 It is also there for prolonged period of time and requires counseling and reassurance apart from unequivocal treatment.Triple assessment test is essential for the patients with complaints of breast diseases.19 Any clinical or suspicious lesion requires pathological diagnosis. Patients with proliferatory disease without atypia have very little(a) risk of breast cancer but patients with atypia have substantial great risk of breast cancer.6The common age group for BBD is younger age group, who have less say in the family. The symptoms are considered trivial and soreness converts in pain.FNAC had high predictive value. In our study there was high sensitivity to fibroadenoma. 12,19The poor sensitivity to fibroadenosis is due to poor cellular aspirate. common FNAC were required some times as th e disadvantage of scaring of excision biopsy and ruin to ductal trunk architecture was not acceptable.21,22,23In studies done by Abhijit M. G. in rural area of karnatak, India in year 2009- 2011 there is high incidence of fibroadenoma, total pt were 110, 68 underwent exicision( 61.8%)of which 60 (88.2%) were fibroadenoma.In Pakistan study done by Batool et al at Lahore, out of 63 patients of BBD there were 38 patients of fibroadenoma.In our study there were 41.9% of fibroadenoma out of that 29.03 % of cases were less than 2 cm and were treated conservatively were as in 70.9 % of cases were proposed surgery but only 64.6 % of patient got operated. There were 25.9% cases of fibroadenosis.In above studies there less incidence of tuberculosis which is 6.2% in our study. This the matter of concern and required more follow ups. In developing country especially in rural area the treatment of breast disease poses lots of problem care system due to social stigma, illiteracy poverty and lac k of availability of true(p) health care system.CONCLUSIONThe disease of breast which is concluded to be benign may be trivial for family members but it imposes substantial anxiety and stirred day to day life of sufferers.9,23The mean age affected was 32. The common benign breast disorder which we came across is fibroadenoma which is more common in young age.12,19,23 They are best treated surgically though small sized can be managed conservatively with honorable follow up. The disease variant of this disorder phylloids tumor needs more diagnostic confirmations to rule out malignancy, excision and follow-ups.Fibroadenosis and mastalgia patients suffer more as there is no surgical cure and the conservative management is not very affective. Anti gonadotrophins due to androgenic side effects are not tolerated well. Anti oestrogen drugs also do not have good compliance due to systemic side effects like flushing and unwellness and vomiting as they are to be consumed for prolonged peri od of time. semiannual NSAID and lifestyle management was more accepted.Infectious disease were found commonly in lactating females Main concern were patients of tuberculosis which are 6.28 % of all patients and much higher in no. than other studies we came across. 18This was more common in age group of 20-30 yrs. Though all mentioned patient were treated completely to our satisfaction.With senescence, there was complaint of nipple discharge in elderly patients due to ductal ectasia and periductal mastits. It required more detailed and dedicated approach so as to rule out the carcinoma which is higher in this age group.Thus benign breast disease has good forecast but requires thorough investigations and management for desired results.9References18 Mehta G, Mittal A, Verma S. Breast tebibyte Clinical Spectrum and Management. Indian J Surg 201072433- 19 Lopez-Ferrer P, Jimenez-Heffernan JA, Vicandi B, Ortega L, Viguer JM. Fine harry aspiration cytology of breast fibroadenoma a cy tohistologic correlation study of 405 cases. Acta Cytologica 199943579- 20 . Park IA, Ham EK. Fine needle aspiration cytology of palpable breast lesions. Acta Cytologica 1997411131- 21. Iglehart JK, Smith BL. Diseases of the breast. In Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 18th ed. India Elsevier 2008858-61. 22 doubting Thomas JM, Fitzharris BM, Redding WH, Williams JE, Trott PA, Powles TJ, et al. Clinical examination, xeromammography, and fine-needle aspiration cytology in diagnosis of breast tumours. Br Med J 1978211139-41223 Srivatsava A, Dhar A. Benign Breast Disease A drop entity. Recent Advances in Surgery 200610175-2011.TABLE NO 1 ETIOLOGICAL DISTRIBUTIONSCHART 1 OPERATIVE AND CONSERVATIVETABLE NO 2 AGE DISTRIBUTIONCHART 2 SPECTRUM OF DISEASE