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Sx early: redness or crusting of nipple skin
Sx advanced: tingling, itching, sensitivity, burning, nipple pain.
- Paget's dz of the nipple
- Dx: biopsy
- Tx: Surgery
How is LCIS found
- Incidental on Biopsy
- RF inc 1% per year.
Four Phases of Management for Breast mass.
- Clinical Breast exam
- Breast Pain
- MC premenopausal
- Noncyclic pain associated with infection or CA
- If w/ mass or bloody nipple discharge.
- Tx: NSAIDs, Eve primrose oil, avoid caffeine
Most common mass in <30 y/o
Smooth, firm, rounded, mobile
- Dx core or excisional bx
- Size changes with menses or preg
- Excise if growing or over 30yr/old
- LTRF = 2.17 for cancer (IDC)
– 10% malignant
– resembles fibroadenoma
– Tx is wide local excision
– Tetrahydrocannabinol use, spironolactone
– Liver failure
Trichloroacetic acid (chemical peel),
Reglan, Verapamil, Reserpine
- Spontaneous, unilateral, bloody, serous
- Galactorrhea – r/o Prolactinoma
Most common cause of bloody nipple d/c• Diffuse papillomatosis has increased risk of cancer
Intraductal Papilloma – not premalignant
Nonspontaneous, B/L, multiple ducts,greenish, milky is likely benign.
- Ductogram/Ductal excision
– S. Aureus, other bacteria (e.g. Strep)
– Inflammatory Breast Cancer
Breast skin - Painful, cordlike superficial thrombophlebitis
– FIBROCYSTIC CHANGES
– NO INCREASED RISK
– 1-2X INCREASED RISK OF CANCER
– ATYPICAL HYPERPLASIA
– 4-5X INCREASED RISK OF CANCER
Found in 3% of benign breast biopsies.
Associated w/ 13% subsequent development of breast cancer (4x risk factor)
Some may be an under-diagnosed ductal carcinoma in situ
Excisional Biopsy – do not need clear margins
- Atypical Hyperplasia - Marked proliferation and atypia of the epithelium, either
- ductal or lobular.