0:00

So now we have a 40 year old postpartum. No, she

0:03

is lactating female with a new right

0:06

breast.

0:12

Mass. All right.

0:13

Go to the question.

0:16

So what is these least likely diagnosis from the

0:19

answers?

0:24

And I'll go back and I'll move this over so that

0:27

everyone can see.

0:30

All right. Looks like we have our answer.

0:34

All right, so

0:35

We have a bunch of different a bunch of different opinions. It looks

0:38

like a third a third a third. So no one thought access but

0:41

if there's that Pokemon say that there's IDC in

0:44

a third Galactus deal. All right.

0:47

And then what?

0:49

What is the risk of biasing a patient with?

0:53

What is the risk of biopsy in this specific patient?

0:56

And we'll get to all the answers at the end.

1:00

All right, a milkfish still at excellent. Excellent. Excellent.

1:03

Excellent.

1:04

So

1:05

to talk about the first question the least likely diagnosis.

1:08

I want to First describe it and then we're going to

1:11

go to the differential and you'll see why all these are on

1:14

the differential but one is very unlikely, but it's important to keep it

1:17

in mind.

1:18

All right, so we have a mass

1:21

of multiple different echogenicities. We have

1:24

some areas of fluid not a

1:27

ton of hyperemia.

1:29

But there's a little bit so, you know.

1:33

Math that you expect to see a lot of hyperemia. You also

1:36

with an access. Sometimes you can see hyperemia. Sometimes

1:39

you don't like to steal. You wouldn't expect

1:42

hyperemia a galactic feeling and an abscess

1:45

can both be a complex math with cystic and

1:48

solid components as well as mastitis can

1:51

also get some fluid from edema because

1:54

there's not a ton of drainable fluid here. It looks like and then

1:57

of course you're always concerned about invasive Dental carcinoma, which could if

2:00

it was a product and a rapidly growing tumor it could

2:03

have

2:05

Focal areas of hypocal areas

2:08

representing your president. So when we go to the differential

2:11

diagnosis the most common things in a

2:14

woman of this age and lactating is a galactophile acting

2:17

and Noma and abscess or focal methods. So those are the most common

2:20

yes breast cancer can occur. The percentage is

2:23

low and that's why it's the least common. So it's

2:26

important to always go to these first. Well keeping breast cancer

2:29

in mind. And the reason you don't want to automatically jump to this is cancer. This

2:32

is cancer is because biasing these patients is

2:35

difficult. You can give them a mix milk insulin. What happens with the milk

2:38

fistula is when you biopsy

2:41

A mass in A lactating breath you can cause official

2:44

between the milk ducts and

2:47

the surface of the skin and what will happen is the skin the sorry the

2:50

milk will take the path of least resistance. The

2:53

nipple has a lot of resistance, right? If not the milk would just

2:56

squirt out all the time, but it has some resistance to maintain their

2:59

smooth erectile smooth muscle in the nipple to

3:02

keep it.

3:04

The milk in but there won't be any at your biopsy site.

3:07

So the milk will go out the five official of

3:10

the biopsy site and it won't cause the nipple and we'll

3:13

happen is the patient will have to stop breastfeeding because

3:16

the baby won't breastfeed anymore on that side because they won't be getting milk

3:19

and eventually the milk will dry out.

3:21

So you really want to think twice before biasing now,

3:24

if you do have a high sufficient that this is one of those

3:27

small percentage of pregnancy related breast cancers. What you

3:30

want to do is you don't want to use your typical biopsy device.

3:33

You don't want to use your typical 14 gauge spring

3:36

loaded biopsy device or large four biopsy device. My recommendation

3:39

is to do an FNA with

3:42

a 21 gauge needle or less and what that'll tell

3:45

you is are there malignant cells in here or not. If there

3:48

are malignant cells in there, then you proceed to a probiosity because

3:51

breastfeeding is the least of the patient's problems, right? If you get a

3:54

milk fistula, it'll be worth it because the patient needs her breast cancer

3:57

treat it but you hate to get someone to milk fistula if

4:00

they have something benign like a galactic Seal A lactating

4:03

on normal looks very different from this. It's usually circumscribed essentially

4:06

it looks like an fibranoma. So you

4:09

would hate to give someone a milk special and cause them to not be

4:12

able to nurse for a very low percentage of breast cancer. So that's

4:15

why you have a suspicion start with a small needle FNA