Benign Breast Disease July 12, 2007
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Benign Breast Disease
July 12, 2007
Maggie Gordon, R2
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Benign Breast Disease
Breast Anatomy
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A – ducts B – lobules C – lactiferous sinus D – nipple E – fat F – pectoralis major G – ribs and intercostal
muscles
A – duct cells B – basement membrane C – duct lumen
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Benign Breast Disease
By Diagnosis
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Risk Factors
Estrogen replacement Genetic changes
Acquired Congenital, including BRCA1, BRCA2
Protective Anti-estrogens, e.g. Tamoxifen
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Fibrocystic Change
Normal variant 60% of pre-menopausal women ↑ cysts or fibrous tissue in otherwise normal
breast Types
Hyperplasia – 20’s Adenosis – 30’s Cystic disease – 30’s-40’s
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Fibrocystic Disease
Fibrocystic change w/ severe pain nipple discharge excessive lumpiness → suspicion of cancer
Cause = blockage / dilation of ducts
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Duct Ectasia
Distension of ducts Contain crystalline material Can develop localized infection May leave nodule after resolution
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Solitary Papillomas
Arise from cyst Present with sanguinous / sero-sanguinous
discharge
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Fibroadenoma
Benign solid tumours Present as well-defined, mobile masses ↑ with estrogen, pregnancy 2-23% prevalence in adolescents to mid-20’s
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Others
Superficial thrombophlebitis of the thoracoepigastric vein (Mondor's disease)
Mastitis, breast abscess, granuloma Galactocele Fat necrosis (panniculitis) Hamartoma Lipoma Neurofibroma Squamous, apocrine metaplasia Tubular adenoma Sarcoidosis Diabetic mastopathy
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Benign Breast Disease
By Symptoms
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Breast Pain
Normal cyclic breast pain Fibrocystic change Fibrocystic disease, when severe Mastitis Large, pendulous breasts
Cooper’s ligaments stretching Occasionally
Masses, including malignancy Duct ectasia Hidradenitis suppurativa
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Nipple Discharge
Spontaneous, bloody, unilateral: malignancy Provoked, non-bloody, bilateral: benign Milky
Post-partum ↓ thyroid Pituitary tumour → prolactin Meds
OCP TCA’s
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Nipple Discharge
Sticky Cystic changes Duct ectasia
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Breast Mass
Mostly fibroadenoma ≥90% palpable breast masses 20’s to early
50’s are benign
Must exclude malignancy
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Benign Breast Disease
Investigation
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History
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Physical Exam
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Palpation of Mass
“Classic” findings in malignancy Single lesion Hard Immovable Irregular border Skin dimpling over lesion Size ≥2cm
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Imaging
Mammography ≥35y.o.
Ultrasound <35y.o. Dense breasts
May be omitted in women who have lactational nipple discharge or cyclic breast pain as long as there is no breast mass
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Biopsy
Essentially any solid mass
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Benign Breast Disease
Treatment
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Fibrocystic Change
Reassurance Support with appropriate bra Acetaminophen, NSAID’s Cysts can be aspirated May help
↓ fat, caffeine, nicotine Vit E, evening primrose oil
Tamoxifen, danazol ↓ medical estrogen
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Simple Fibroadenoma
Several options Follow with US Core bx, then nothing further
Surgical excision not recommended Up-and-coming: US-guided cryoablation
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Cyst
Aspiration Bloody fluid → cytology Non-bloody fluid → garbage
Follow-up US No recurrence → no further intervention Recurrence → surgical consult