Benign Pathologies of the Breast…


Benign lesions are the most common breast mass, occurring in 70% of biopsies/removals.

Consider the following parameters when a dominant mass has been palpated within the breast: age, physical characteristics of the mass and previous medical history. It is more common to find fibrocystic disease and fibroadenomas in younger women; older women are most likely to have intraductal papillomas, duct ectasia and caner.



Cysts…

Commonly seen in women 35-40 years of age
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Symptoms:
· History of the cyst changing with the menstrual cycle
· Pain (experienced when the cyst is growing rapidly)
· Recent Lump & Tenderness


Types of complex cysts...

  • Galatocele – a milk filled cyst (see photo -> )
      • Typically located in below the areola

      • Caused by obstructed lactiferous duct

  • Sebaceous cyst
    • Caused by an obstructed sebaceous gland within the skin


* Photo: Complex mass, galactocele. Transverse sonogram of palpable mass occupying most of the breast obtained in a 18-year-old woman shows a complex cystic (C) and solid (S) mass. Aspiration was performed for symptomatic relief, yielding 250 mL of breast milk.

http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=2&cat2=11&cat3=407&cat4=1&stype=n

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Fibroademoma… ~ Most common benign breast tumor~

· Firm, smooth, rubbery or hard lump with a well-defined shape
· Moves easily under your skin when touched and is usually painless
· More common among women in their 20’s and 30’s
· Range in size from less than 1 cm to several centimeters in diameter.
· Treatment may include careful monitoring to detect changes in the size or feel of the fibroadenoma or surgery to remove it.
· Do not change size during the menstrual cycle, but can get bigger during pregnancy and breast-feeding
· Tend to grow very slowly
· A sudden increase in size with acute pain = hemorrhagic cyst

Sonographic Signs:
· Smooth, rounded margins, low-level homogeneous internal echoes w/ possible posterior enhancement



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Fibrocystic Condition (FCC) - AKA: Lumpy Breasts



FCC involves the glandular breast tissue. Estrogen and progesterone directly affect the breast tissues by causing cells to grow and multiply; which contribute to the feeling of breast fullness and fluid retention that women commonly experience before their menstrual period.
However, when the monthly cycle is over these stimulated breast cells cannot simply slough away and pass out of the body. Instead, many of these breast cells undergo death, called apoptosis. This leads to scarring (fibrosis) that damages the ducts and the lobules of glandular tissue within the breast causing “lumpy breasts.”



Sonographic Signs: round masses as multiple cysts


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Lipoma

Pure Lipoma – consist entirely of fatty tissue

  • Other forms include fibrous and glandular elements within the fatty tissue
  • May grow quite large prior to detection
  • Usually middle aged or menopausal women
  • Clinical Palpation:
  • Large, soft, w/ irregular borders; connot be separated from surrounding breast tissue

Sonographically:

  • Very difficult or impossible to see
  • Typically smooth walls, hypoechoic - appears similar to fat
  • Poor enhancement
  • Compressible


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Mastitis… yes an ‘itis’

· Inflammation of the mammary gland
· Causes are infections and bacteria
· Mostly occurs during lactation
· Often confined to one area
· Acute & Chronic classifications

Clinical signs:

· Pain, redness, and tenderness of the affected portion of gland
· Abnormality of the milk (clots or flakes, and wateriness)


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Abscess

· Hollow space in the breast that is filled with pus & surrounded by inflamed tissue
· Often a complication of mastitis

Other causes:

· Mostly occur in breastfeeding women due to cracked nipples
· overweight women w/ large breasts
· poor personal hygiene
· smoking

Sonographic Signs:

· Acute Abscess – poorly defined borders
· Mature Abscess – well encapsulated, sharp borders
**Color Doppler may be helpful in detecting increased vascularity

Diagnosis must be made upon aspiration, not on mammography alone

Clinical Signs:
· Pain, swelling, reddening of skin
· Axillary nodes may be swollen & painful



Cystosarcoma Phyllodes untitled.JPG

  • Rare, predominantly benign
  • Comprises less than 1% of all breast neoplasms, yet it is the most frequent sarcoma of the breast
  • Usually unilateral
  • May arise from a fibroadenoma
  • Usually grows rapidly
  • 27% are considered malignant; 12% metastisize

Clincal Signs
  • Deliniated, firm, mobile
  • Skin changes may develop caused by increasing pressure as the mass becomes lobulated and irregular
  • Edema may produce a skin change
  • As pressure increases it causes trophic changes and eventual skin ulcerations
    • Infection and abcess may be a secondary complication

Sonographic Signs
  • Large, hypoechoic tumor
  • Well defined margins
  • Decreased through-transmission
  • Internal echoes may be fine or course with variable amounts of shadowing




Intraductal Papilloma 33288-Afbeelding1.jpg

  • Small, benign tumor
  • Grows within the acini of the breast
  • Occurs in women 35-55 years

Clinical Signs
  • Spontaneous nipple discharge arising from a single duct
  • When discharge is copious
    • usually preceeded by a sensation of fullness or pain in the areola area and is relieved when fluid is expelled
  • Has a "raspberry-like" configuration on the mammogram
  • May grow large in size and become palpable

Sonographic Signs
  • Usually small, multiple, and multicentric
  • Consist of simple perliferations of duct epithelium projecting outward into a dilated lumen from one or more focal points, each supported by a vascular stalk