BENIGN+PATHOLOGIES

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 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

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. <span style="background: none repeat scroll 0% 0% white; line-height: 18pt; margin: 0in 0in 10.45pt 0.5in; text-indent: -0.25in;"> · <span style="color: #54585a; font-family: 'Arial','sans-serif'; font-size: 12pt;">Treatment may include careful monitoring to detect changes in the size or feel of the fibroadenoma or surgery to remove it. <span style="background: none repeat scroll 0% 0% white; line-height: 18pt; margin: 0in 0in 10.45pt 0.5in; text-indent: -0.25in;"> · <span style="color: #54585a; font-family: 'Arial','sans-serif'; font-size: 12pt;">Do not change size during the menstrual cycle, but can get bigger during pregnancy and breast-feeding <span style="background: none repeat scroll 0% 0% white; line-height: 18pt; margin: 0in 0in 10.45pt 0.5in; text-indent: -0.25in;"> · <span style="color: #54585a; font-family: 'Arial','sans-serif'; font-size: 12pt;">Tend to grow very slowly <span style="background: none repeat scroll 0% 0% white; line-height: 18pt; margin: 0in 0in 10.45pt 0.5in; text-indent: -0.25in;"> · <span style="color: #54585a; font-family: 'Arial','sans-serif'; font-size: 12pt;">A sudden increase in size with acute pain = hemorrhagic cyst

<span style="background: none repeat scroll 0% 0% white; color: #54585a; font-family: 'Arial','sans-serif'; font-size: 16pt; line-height: 18pt; margin: 0in 0in 10.45pt;">Sonographic Signs: <span style="background: none repeat scroll 0% 0% white; line-height: 18pt; margin: 0in 0in 10.45pt 0.5in; text-indent: -0.25in;"> · <span style="color: #54585a; font-family: 'Arial','sans-serif'; font-size: 12pt;">Smooth, rounded margins, low-level homogeneous internal echoes w/ possible posterior enhancement

<span style="background: none repeat scroll 0% 0% white; color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 18pt; margin: 0in 0in 10.45pt;">

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



<span style="background: none repeat scroll 0% 0% white; color: black; font-family: Calibri; font-size: 22pt; line-height: 18pt; margin: 0in 0in 10.45pt;">Lipoma

<span style="background: none repeat scroll 0% 0% white; color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 18pt; margin: 0in 0in 10.45pt;">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

<span style="background: none repeat scroll 0% 0% white; color: black; font-family: 'Arial','sans-serif'; font-size: 16pt; line-height: 18pt; margin: 0in 0in 10.45pt;">Sonographically:


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

Mastitis… yes an ‘itis’

· <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 115%;">Inflammation of the mammary gland · <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 115%;">Causes are infections and bacteria · <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 115%;">Mostly occurs during lactation · <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 115%;">Often confined to one area · <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 115%;">Acute & Chronic classifications

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 16pt; line-height: 115%; margin: 0in 0in 0pt;">Clinical signs:

· <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 115%;">Pain, redness, and tenderness of the affected portion of gland · <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 115%;">Abnormality of the milk (clots or flakes, and wateriness)

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 22pt; line-height: 115%; margin: 0in 0in 0pt;">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 <span style="color: black; font-size: 12pt; line-height: 15.6pt; margin-left: 0.5in; text-indent: -0.25in;">**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

<span style="font-family: 'Arial','sans-serif'; font-size: 22pt; line-height: normal; margin: 0in 0in 10pt;">Cystosarcoma Phyllodes


 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Rare, predominantly benign
 * <span style="color: windowtext; font-family: 'Arial','sans-serif'; font-size: 12pt;">Comprises less than 1% of all breast neoplasms, yet it is the <span style="font-family: 'Arial','sans-serif'; font-size: 12pt;"> most frequent **__sarcoma__** of the breast
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Usually unilateral
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">May arise from a fibroadenoma
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Usually grows rapidly
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">27% are considered malignant; 12% metastisize

<span style="font-family: 'Arial','sans-serif'; font-size: 14pt; line-height: normal; margin: 0in 0in 10pt;">Clincal Signs
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Deliniated, firm, mobile
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Skin changes may develop caused by increasing pressure as the mass becomes lobulated and irregular
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Edema may produce a skin change
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">As pressure increases it causes trophic changes and eventual skin ulcerations
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Infection and abcess may be a secondary complication

<span style="font-family: 'Arial','sans-serif'; font-size: 14pt; line-height: normal; margin: 0in 0in 10pt;">Sonographic Signs
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Large, hypoechoic tumor
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Well defined margins
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Decreased through-transmission
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Internal echoes may be fine or course with variable amounts of shadowing

<span style="font-family: 'Arial','sans-serif'; font-size: 22pt; line-height: normal; margin: 0in 0in 10pt;">Intraductal Papilloma


 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Small, benign tumor
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Grows within the acini of the breast
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Occurs in women 35-55 years

<span style="font-family: 'Arial','sans-serif'; font-size: 14pt; line-height: normal; margin: 0in 0in 10pt;">Clinical Signs
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Spontaneous nipple discharge arising from a single duct
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">When discharge is copious
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">usually preceeded by a sensation of fullness or pain in the areola area and is relieved when fluid is expelled
 * <span style="color: red; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Has a "raspberry-like" configuration on the mammogram
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">May grow large in size and become palpable

<span style="font-family: 'Arial','sans-serif'; font-size: 14pt; line-height: normal; margin: 0in 0in 10pt;">Sonographic Signs
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">Usually small, multiple, and multicentric
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: normal; margin: 0in 0in 10pt;">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