60 yr lady had a lump excision 5 years back from RT breast . Now she developed a lump about 10cmx10cm 8cm as shown in photograph from the same breast . Pus comes out from nippple when pressed.No axillary lymphadenopathy.Liver ,spleen not palpable.Clinically breast abscess. Why I posted this case? To know if a breast malignancy ever suppurates ? What should be my approach as two Fnac done elsewhere are inclusive.I aspirated Pus from this swelling. Do inflammatory breast malignancy appear at 60 years of age?

*Fibroadenomas* ☝today about ☝ are not cancerous. They range in size from smaller than a marble to as large as a golf ball. Most appear suddenly and stay the same size. Some shrink or continue to grow. They are affected by hormones and often change size over the menstrual cycle or during pregnancy. Fibroadenomas are usually rubbery and firm, but they can be difficult to feel properly. If you push on the lump, you will probably find that it moves away from beneath your fingers. This is why some people call a fibroadenoma a ‘breast mouse’. Fibroadenomas do not move far within the breast. Usually, fibroadenomas are not painful. However, they can be uncomfortable or very sensitive to touch. Often women find that their fibroadenoma gets tender in the days before their period. Pushing or prodding at the lump can also make it tender. Epidemiology They usually occur in women between the ages of 10 and 40 years. It is the most common breast mass in the adolescent and young adult population. Their peak incidence is between 25 and 40 years. Incidence decreases after 40 years. Types Simple fibroadenoma Most fibroadenomas are about 1–3cm in size and are called simple fibroadenomas. When looked at under a microscope, simple fibroadenomas will look the same all over. Simple fibroadenomas don’t increase the risk of developing breast cancer in the future. Complex fibroadenoma Some fibroadenomas are called complex fibroadenomas. When these are looked at under a microscope, some of the cells have different features. Having a complex fibroadenoma can very slightly increase the risk of developing breast cancer in the future. Juvenile fibroadenomas This is the most common type of breast lump found in girls and adolescents between the ages of 10 and 18. These fibroadenomas can grow large, but most shrink over time, and some disappear. Giant fibroadenomas These can grow to larger than 2 inches (5 centimeters). They might need to be removed because they can press on or replace other breast tissue. Phyllodes tumor Although usually benign, some phyllodes tumors can become cancerous (malignant). Doctors usually recommend that these be removed. Risk factors Common risk factors of Fibroadenoma of the Breast include: Estrogen therapy or other hormone therapies Pregnancy Breastfeeding Use of birth control pills It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. Causes The exact cause of Fibroadenoma of Breast is unknown. Though common associated factors are- Hormones: Especially Estrogen seems to play a significant role in both growth and maintenance of these benign tumors. Oral Contraceptive pills (OCP): These are the medicines, basically female hormone combinations which prevents ovulation thereby prevents pregnancy. OCP can also cause Fibroadenoma of the breast. HRT (Hormonal Replacement Therapy) given in some cases of menopause due to excessive menopausal symptoms can cause fibroadenoma of the breast due to estrogen hormone. Symptoms Following are the alarming symptoms of fibroadenoma of the breast: Lump under the breast skin usually felt by fingers on touching Firm mass Rubber like or marble like consistency Easily movable within the breasts Has well-defined edges & smooth shape in most cases They do not cause pain usually but it depends on the location of growth Every woman’s breast is influenced by Estrogen but not all get Fibroadenomas which shows that mere removal of fibroadenoma is not sufficient, but holistic treatment like Homeopathy is required. Complications Most fibroadenomas don’t affect your risk of breast cancer. However, your breast cancer risk might increase slightly if you have a complex fibroadenoma or a phyllodes tumor. Diagnosis and test Diagnosis is based on the ‘triple test’. The triple test is: The clinical assessment: A fibroadenoma usually feels very mobile but is firm. It can be freely moved over the muscle and can be moved under the skin. It is not usually painful but may be slightly tender if it is pushed hard. The imaging of the lump: Ultrasound of the breast is often better than mammography in young women as the breasts are denser so are not able to be compressed as easily as in older women. The appearance of a fibroadenoma on ultrasound is that of a solid lump with a regular outline. A mammogram may show a dense mass that is smooth in outline. Assessment of the cells or tissue: There is a typical appearance of a fibroadenoma under the microscope. If all of the tests above suggest that the lump is a fibroadenoma and not cancer, then it is likely to be that. If even one of the tests suggests that it is a cancerous lump then the lump should be removed. Treatment Treatment for fibroadenomas may not be necessary unless they are large, painful or cosmetically undesirable, in which case they can be removed. Fibroadenomas do not grow back after they are removed; however, some women develop new fibroadenomas after having previous lumps removed. The following treatment possibilities are available: Watchful Waiting – Fibroadenomas may be left in place and monitored for growth. Women with multiple non-growing lumps may choose this tactic because removal would affect the shape of the breast. Excision – Cutting out fibroadenomas with a scalpel, or traditional excision, is a treatment method used in some cases. Percutaneous Excision – Sometimes fibroadenomas are removed by percutaneous (through the skin) excision. With this method, a small slit is made in the skin near the lump and an ultrasound-guided probe with a vacuum is used to extract the fibroadenoma in sections. Cryoablation – Another treatment method used for some fibroadenomas is cryoablation, which destroys the lumps by freezing them without removing them. An ultrasound-guided probe is placed into the center of the lump through a small incision in the skin to perform the procedure. Women with fibroadenomas may need to be followed regularly by their doctors through clinical breast exams and imaging tests such as mammograms (breast X-rays) or ultrasound if the lumps are left in place or if they have multiple or complex lumps that increase the risk for breast cancer. Steps of cryoablation Prevention Fibroadenoma of the Breast is difficult to prevent because it is most likely caused by abnormal or fluctuating reproductive hormone levels Since prevention is generally not possible, it is important to be aware of the risk factors for breast lumps. The individual must also regularly conduct breast self-exams, to ensure that any lumps are not present.

42 year old lady with a fungating breast lesion X 5 months duration. Extensive matted LN in right Axillary and Lymphedema in the right UL. Supraclav LN present as well. IDC - grade 3. TNBC. Metastasis to lungs, liver. Let's discuss the management. It is sad to see such advanced cases.

59 year old male came with a lesion over the tongue for the last 3 days. It was associated with pain and fever. This occurred following the first dose of chemotherapy for male breast cancer. What are your thoughts about the lesion?

42 year old lady underwent surgery for breast cancer and she was unable to pass urine in the post op period and she required catheterisation. Greenish urine came out after catheterisation. Let's see who can guess the cause for this kind of urine after breast surgery