Go Back   Medical Educational Web > Medical news (researches and texts) > Surgery and Surgical Subspecialties
FAQ Members List Social Groups Calendar Search Today's Posts Mark Forums Read

Surgery and Surgical Subspecialties Discuss surgery and surgical subspecialties


ANDI ( Aberration of Normal Development and Involution) Involutional cystic hyperplasia

Surgery and Surgical Subspecialties


Reply
 
Thread Tools Rate Thread Display Modes

Old 11-29-2009, 08:21 AM   post no: 1
Admin
Administrator





Admin is offline



 From his posts
 



Default ANDI ( Aberration of Normal Development and Involution) Involutional cystic hyperplasia



ANDI ( Aberration of Normal Development and Involution)
Involutional cystic hyperplasia, Mammary dysplasia,
Fibroadenosis, cysic disease of the breast
"The commonest disease of the female breast"
Pathogenesis:
Due to fluctuation of oestrogen level during reproductive period or menopause. The breast gland may undergo abnormal development or involution which give:
(1) Glandular hyperplasia: Increase number of acini with increase cells inside which form papillary projections inside the acini. ( adenosis, epitheliosis and papillomatosis). The acini appears as solid masses of cells.
(2) Connective tissue hyperplasia: fibrous tissues will replace many epithelial elements (Fibrosis).
(3) Cyst formation:
(A) Large cysts: due to obstruction by fibrosis with accumulation of secretions.
(B) Small cysts: due to abnormal involution of the ducts.
Sometimes; one or many large cysts are formed at the pre-menopausal period with atrophy of the lobules of the breast with accumulation of fluid inside it and referred as "Blue-domed cysts of Blood good".
(4) Lymphocytic infiltration: occurs early in the disease. Hence the old name chronic interstitial mastitis.
Relation of the disease with CA. breast:
Due to high incidence of CA. breast with the disease
- Some say that it is precancerous "on top of its hyperplasia".
- Others say that it is only coincidental lesion.
Clinical Picture:
Incidence:- Common in apprehensive & tense females.
1- 20 : 40 years of age.
2- Spinsters, nullipara & those who did not suckle her infants
Complaint:
1- Painful lump or lumps in the breast which normally bilateral.
- The pain becomes more just before menstruation.
2- Discharge per nipple
Examination:
(1) The mass difficulty felt by flat of the hand but clearly felt by tip of the fingers.
(2) Brownish or black discharge "D.D. of bloody discharge of the nipple".
(3) Axillary lymph nodes may be enlarged, firm and tender.
Differential Diagnosis: From other causes of hard lump in the breast:
1- CA breast. 2- Ch. breast abscess.
3- Plasma cell mastitis. 4- Traumatic fat necrosis.
The differences from cancer are:
Fibroadenosis
Carcinoma
1- Usually bilateral and diffuse, but rarely localized (sector type).
Usually unilateral and localized.
2- Difficult to feel it by flat of the hands.
Felt easily by both flat of the hand and tips of the fingers.
3- The masses are not attached to skin or pectoral fascia.
May be attached to both causing dimpling or puckering of the skin.
4- Nipple retraction, if present it is usually old not recent retraction.
It may cause recent nipple retraction
5- Axillary Lymph nodes if enlarged never to be hard.
Lymph nodes if enlarged are hard and may be fixed

Treatment:
I) Conservative treatment:
1- Reassurance : tell the patient that it's not pre-malignant .
2- Support of the breast by firm brassiere.
3-Analgesics to relieve pain.
4- Very rarely an antioestrogen is necessary to deprive the breast epithelium from oestrogenic drive.
5- Antiprolactin (parlodel) is given in cases with discharge per nipple in a dose of 2.5 mg twice daily for 3 months. Starting with small doses incrasing gradually can prevent nausea, headache, irritability and hypotension which may occur with parlodel therapy.
II) Surgical treatment:
1- Localized mass do Excision biopsy .
2- Multiple cysts involving most of the breast do subcutaneous mastectomy and replacement of breast tissue by synthetic prosthesis "Augmentation mammoplasty"
F N.B. Types of Mammoplasty:
1- Excision mammoplasty as in gynaecomastia.
2- Reduction mammoplasty as in diffuse hypertrophy.
3- Augmentation mammoplasty as in "Fibroadenosis".
SOURCE: Prof. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (Vascular Society of Egypt ) &Medical Educational web (Medical Educational web)
Not to be reproduced without permission of Vascular Society of Egypt











Signature:
  Reply With Quote
Reply

Bookmarks

Tags
aberration, andi, cystic, development, hyperplasia, involution), involutional, normal

« Mondors disease | Benign tumours of breast »
Thread Tools
Display Modes Rate This Thread
Rate This Thread:

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump