Kelainan jinak payudara

Dr Emir T Pasaribu Sp B (K) Onk

Dr. Suyatno SpB(K) Onk
Bagian I Bedah FK USU /
RS. HAM Medan

ANATOMI

Nipple location

4th intercostal
space

Pendahuluan
Merupakan kelainan terbanyak 90 %
Sir Astley Cooper (1829)
- fibrokistik, fibroadenosis, pain, FAM.
French surgeon Reclus (1893)
- aspek klinis dan patologis
Foot & Stewart (1945)
- chronic cystic mastitis --- lokal eksisi

Pendahuluan
Kelainan Jinak
Risiko
- lesi non proliferasi (70 %)
- lesi proliferasi tanpa atipik
- hyperplasia dengan atipik

0,89
1,5 2
35 - 5

Penyebab Benjolan di Payudara

Breast Disease, Marcia Corner, Peggy Mancuso, CNM

Program Editior.

Kelainan jinak lain

Breast hipertrophy
Amastia, symastia, hipoplasia
Tubular breast
Mammary aberrant (Ectopic axillary
breast tissue, supernumerary breast)
Supernumerary nipple

Amastia
(congenital
absence one
Or both
breasts)

Symastia :
medial
confluence
of the breast

HIPOPLASIA
payudara kiri
+
hipertrophy
dan ptosis
payudara
kanan

Tubular dan
hipoplasia
kedua
payudara

Breast
Hipertrophy
Bilateral =
Macromastia =
Gigantomastia

Mammary
Abberan =
Polimastia =
Supernemary
breast
=

Ectopic breast

Diagnosis
Pemeriksaan klinis
- riwayat penyakit (Anamnesis)
- inspeksi
- palpasi
Pemeriksaan imaging
USG: < 40 thn,
Mamografi : > 40 thn
Pemeriksaan Patologi (Biopsi)

Deteksi Dini (skrining):

SADARI (SBE)

Posisi berdiri

Posisi berbaring

Posisi berbaring dengan bantal diletakan di punggung

INFECTIOUS / INFLAMMATORY

Mastitis
Usual etiologic : Staphylococcus aureus
or Streptococcus spp. & Tbc(rare)
Most commonly occurs during early
weeks of breast-feeding
Tuberculosis of the breast is rare
disease. However, both clinical and
radiological features of tuberculous
mastitis, can be confused with either
breast cancer or pyogenic

MASTITIS AKUT

 Phisical exam :
Focal tenderness with erythema
warmth of overlying skin
fluctuant mass Occasionally
palpable.
Diagnosis : Ultrasound can be used
to localize an abscess

Treatment
1. Breast pump
2. Contralateral breast: Safe
3. Cellulitis : Wound care and
IV antibiotics
4. Abscess : Incision and
drainage followed by IV
antibiotics

Abses Payudara

INFECTIOUS / INFLAMMATORY

Fat Necrosis
Presentation :
Firm
irregular mass of varying tenderness
History of trauma; in 50% of patient
Predisposing factors : Chest wall or
breast trauma
There is no association with ca. or ca. risk

 Physical exam : Irregular mass without

discrete borders that may or may not be
tender ; later, collagenous scars
predominate
Often indistinguishable from
carcinoma by clinical exam or
mammography
Diagnosis and treatment : Excisional
biopsy with pathologic evaluation for
carcinoma

BENIGN DISEASE

Fibroadenoma (FAM)
Definition : Fibrous stroma surrounds
duct-like epithelium and forms a benign
tumor
Risk factors : More common in black
women than in white women.
Incidence : Typically occurs in late teens
to early 30s; estrogen-sensitive
(increased tendernessduring pregnancy).

Variant/ Tipe FAM

Hamartoma, (usia 2 dekade >>)
Tubular adenoma, (dominan elemen

tubula dengan sedikit stroma)

Lactating adenoma
Juvenile fibroadenoma
Giant fibroadenoma , (Size > 5 cm)
Complex FAM :(kista, sklerosing adenosis,
kalsifikasi epiteleal)

 Signs and symptoms :

Smooth, discrete, circular, mobile
Diagnosis : Clinical + USG + FNA
Treatment :
observe if age < 30 & size <3cm
excise mass: over 30 years
symptomatic
size > 3 cm

Fibroadenoma

19 tahun, giant FAM

BENIGN DISEASE

Mondors Disease
Definition : Superficial thrombophlebitis
of lateral thoracic or thoracoepigastric
vein.
Predisposing factors : Local trauma,
surgery,. Infection, repetitive
movements of upper extremity.
Presentation : Acute pain in axilla or
superior aspect of lateral breast.
Physical exam : Tender cord palpated.

Mondors Disease

 Diagnosis : Confirm with ultrasound.

Treatment :
Warm compresses, limit motion of
affected upper extremity. Usually
resolve within 2 to 6 weeks.
If persistens, surgery to divide the
vein above and below the site of
thrombosis or resectthe affected
segment.
Usg nondiagnostic or an associated
mass present : Excisional biopsy.

BENIGN DISEASE

Intraductal Papilloma

Definition : A benign local

proliferation of ductal epithelial cells.
Characteristics : Unilateral
serosanguineous or bloody nipple
discharge.
Presentation : Subareolar mass and /
or spontaneous nipple discharge.

 Evaluation : Radially compress breast

to determine which lactiferous duct
expresses fluid ;USG, mammography.
Diagnosis : Definitive diagnosis by
pathologic evaluation of resected
specimen
Treatment : Excise affected duct.

Microdoechtomy

BENIGN DISEASE

Phyllodes Tumour
Majority are benign.
Malignant phyllodes sarcoma
Patients tend to present later than those
with fibroadenoma (>30 years).
Indistinguishable from FAM by usg or
mammogram.
phylloides tumors have more mitotic
activity

 Exam : Large, freely movable mass

with overlying skin changes.
Diagnosis : Definitive diagnosis
requires biopsy with pathologic
evaluation
Treatment :
Smaller tumors : Wide local excision
with at least a 1-cm margin
Larger tumors : Simple mastectomy

Phyllodes Tumour

BENIGN DISEASE

Mammary Duct Ectasia (Plasma Cell

Mastitis)
Definition : Inflammatory and dilation
of mammary ducts.
Most commonly occurs in the
perimenopausal years.
Presentation : Noncyclical breast pain
with lumps under nipple/areola with or
without a nipple discharge.

 Exam :
Palpable lumps under areola, possible
nipple discharge
Diagnosis :
Clinical exam
Duktulografi identi. affected duct
Excisional biopsy
Treatment :
Excision of affected ducts

BENIGN DISEASE

Fibrocystic Changes
Usually

diagnosed in 20s to 40s.

Presentation : Breast swelling (often
bilateral), tenderness, and/or pain.
Physical exam : Discrete areas of
nodularity within fibrous breast tissue.
Evaluation : Fluctuating of the symtoms is
usually sufficient unless a persistent
discrete mass is identified
Definitive diagnostic: FNAB or biopsy with
pathologic evaluation.

Fibrocystic Changes
Symtoms thought to be of hormonal
etiology and tend to fluctuate with the
menstrual cycle
Each of which has a variable relative
risk for the development of cancer
Not associated with an increased risk

for breast cancer unless biopsy reveals

lobular or ductal hyperplasia with atypia

Treatment :
Conservative management: classic
history or absence of a persistent
mass (NSAIDs, EPO,danazol, or
tamoxifen)
Single dominant cyst, aspirate
fluid ;
send to cytology
Excise cyst if bloody.

Solid - Cyst

Galaktokel
Fitzwilliams 1845
Kista berisi susu, sering pada masa laktasi
Bersamaan dengan duct ectasia dan

recurrent sub areola abses

Klinis timbul massa tanpa nyeri setelah
beberapa minggu/ bulan menyapih
Dapat hilang sendiri a setelah aspirasi
Lokasi tersering sub areola

Galaktokel gambaran
klinis dan USG

BENIGN DISEASE

Gynecomastia

Definition : Development of female-like breast tissue

in males ( enlargement of ductal and stromal tissue)
Presentation: male with swelling of the breast, often
unilateral
May be physiologic (primary) or pathologic
(secondary).
Primary: infantile, adolescence, adult
Secondary: decreased androgen, increased
oestrogen , drug induced

Ditemukan pada 60 % remaja normal

Insiden tertinggi: 10-16 tahun
Risiko keganasan 1%
Grading menurut Simon:

G. I. Ukuran kecil tidak ada kelebihan kulit

G.II. Ukuran sedang tidak ada kelebihan kulit
G.III. Ukuran sedang dengan kelebihan kulit
G.IV. Ukuran besar seperti payudara wanita

Treatment :
Treat underlying cause if specific

cause identified
Indication of surgical excision are:
Reassurance is inadequate
Drug treatment inappropriate or
unstisfactory

Gynecomastia
Unilateral
(subkutan mastektomi
dengan insisi V)

Tehnik operasi
terbaru untuk
Ginekomastia
(Subkutan mastektomi
dengan Periareolar
incision )

Terima Kasih
Thank you
Gracias