The Breast Diseases 乳
腺
疾
病
Gu Yuanting 谷
元
Department of Breast
廷 乳 腺 科
1. Anatomy and physiology Each mammary gland consists of 15 to 20 glandular lobes or acini Much like a bunch of grapes
The lymphatic network of the breast is very rich and drainage is extensive in many directions from the breast itself. The major and primary route of drainage is the axillary pathway.
The lymphatic network of the breast
Axillary lymph nodes
Cyclic change in the breast occurs during each menstrual cycle. During pregnancy, delivery and lactation, breast also undergoes a series changes.
2. Breast Examination 检
查
(1) Inspection 望 诊 Abnormal variations in breast symmetry, size shape, skin color Nipple retraction, excoriation, inversion, discharge, edema, or redness Slight edema or retraction of the skin
Nipple retraction
Abnormal variation
Nipple discharge
(2) Palpation 触 诊 Breast (mass, cystic hyperplasia, etc.) Gentle palpation with fingertips is essential and a systematic examination, quadrant by quadrant, must be carried out
Axilla (lymph nodes ) Supraclavicular areas (lymph nodes )
(3) History 病 史 Lump or mass 肿 块 Pain 疼 痛 Nipple Bleeding or Discharge 乳 头 溢 血 或 溢 液 Previous breast masses, biopsies etc. 以往乳腺肿块病检 Menstrual History 月 经 史 Obstetrical history 生 产 史 Exogenous hormones 外 源 激 素 应 用 史 Systemic symptoms 全 身 症 状
nipple discharge Serous, colorless discharge can occur during normal menstrual cycles, result from intraductal papilloma, or accompany early pregnancy. A bloody discharge is usually associated with either intraductal papilloma or ductal carcinoma.
X-ray examination of breast Mammography and Xeroradiography offers an opportunity to identify breast cancer. The more definite radiologic signs of breast cancer are mass lesions with poorly defined margins, particularly when the edges are either speculated or irregular. Fine, stippled soft tissue and periductal calcification are also important findings.
Mammography
Pathological examination Cytology (for discharge, etc.) Needle aspiration Excisional biopsy Needle biopsy Incisional biopsy (frozen section during operation, etc.)
Other examinations for breast 其 他 Ultrasonic Scanning 超 声 Infrared camera 红外线透照 Thermography 皮 温 测 量
3. Acute Mastitis and Breast Abscess 急 性 乳 腺 炎 和 乳 腺 脓 肿
Acute mastitis due to bacterial infection most commonly occurs within the first few weeks of lactation. It is caused by bacteria.
Etiology Stasis of milk Invasion of bacteria (staphylococci or streptococci )
(1) Clinical findings 临 床 特 点
Abstract: Commonly occurs within the first few weeks of lactation. 发 生 于 哺 乳 期 Malaise, (at the onset of infection) 不 适 Pain, hot, tense and tender of the breast 红 肿 热 痛 The body temperature is raised and rigor may occur 全 身 寒 战 高 热
The breast feels full and tense with induration and tenderness. The induration softens when the formation of abscess occurs. 硬 结 和 脓 肿 Systemic toxic manifestations may occurs 全 身 中 毒 表 现 To diagnose a deeply situated abscess can be made by an aspiration using large size needle. 针 吸 诊 断 深 部 脓 肿
abscess
(2) Treatment: 治疗 The healthy breast can still be nursing. A breast pump should empty the milk of infected breast.
吸 尽 乳 汁
Fomentation (by 25% magnesium sulphate) Application of antibiotics Incision and drainage
热 敷
抗 生 素 应 用
切 开 引 流
Incision and drainage
2 Cystic Hyperplasia (Mammary dysplasia) 囊 性 增 生（乳腺结构不良症）
This is the most common lesion in the female breast, represents a variant of the normal cyclic changes in the breast that occur with menstruation. Mammary dysplasia usually occurs in the age of 25~40.
Etiology Hormonal imbalance
Pathology Proliferative change in epithelium and connective tissues, often with cystic dilatation of ducts and acini
2~3% of mammary dysplasia may have malignant change
(1) Essentials of diagnosis
诊断要点
Painful, often multiple, frequently bilateral masses in the breast
乳腺对称性多发疼痛肿块
Frequently, pain occurs or increases and size increases during premenstrual phase of cycle 月经前肿块增大、疼痛加重
Most common age is 25-40. Rare in postmenopausal women
好发于 25-40 岁
(2) Treatment 治
疗
Give drugs to soften the lump and subside symptoms, such as Lugol’s solution and Traditional Chinese herbs ( 乳癖消、乳宁颗粒、乳癖散 结胶囊等 )
In extreme cases, Tamoxifen (10mg bid po) is given
surgical operation Over 40 years old, with solid, hard lumps and family history, excision of mammary lobe or simple mastectomy should be performed. If malignancy is proved, radical mastectomy should be done.
3. Fibroadenoma of the breast 腺 纤 维 瘤
This common benign neoplasm occurs most frequently in young women the age between 18-25. The lesions grows rapidly during pregnancy and rare after the menopause. 常见良性瘤，好发于 18-25 岁，怀孕时生长快
Fibroadenoma
Fibroadenomas
Diagnosis: 诊断 The typical fibroadenoma is a round, firm discrete relatively movable, nontender mass 1-5 cm in diameter. The tumor is usually discovered accidentally, the clinically diagnosis in young patients is generally not difficult. 瘤体圆形、坚硬、活动， 1-5cm 大小
Treatment 治 疗 In all cases is excision and pathologic examination to determine if the lesion is cancerous. 切 除、 病 检
Excision of fibroadenoma
Intraductal papilloma
These benign lesions of the lactiferous duct walls occur centrally beneath the areola in 75 per cent of the cases. They most commonly produce a bloody nipple discharge.
nipple discharge
The duct affected with discharge
These papillomas may be soft, small, and difficult to palpate. Ductograms, as discussed earlier, can also be very useful
Intraductal papillomas are always benign, but 6% to 8% of the cases may have malignant change.
Treatment: Intraductal papillomas should be treated by excision of the duct as a wedge resection.
During the operation of breast