Benign Breast Disease July 12, 2007

Benign Breast Disease

July 12, 2007

Maggie Gordon, R2

Benign Breast Disease

Breast Anatomy

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

Benign Breast Disease

By Diagnosis

Risk Factors

Estrogen replacement Genetic changes

Acquired Congenital, including BRCA1, BRCA2

Protective Anti-estrogens, e.g. Tamoxifen

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

Fibrocystic Disease

Fibrocystic change w/ severe pain nipple discharge excessive lumpiness → suspicion of cancer

Cause = blockage / dilation of ducts

Duct Ectasia

Distension of ducts Contain crystalline material Can develop localized infection May leave nodule after resolution

Solitary Papillomas

Arise from cyst Present with sanguinous / sero-sanguinous

discharge

Fibroadenoma

Benign solid tumours Present as well-defined, mobile masses ↑ with estrogen, pregnancy 2-23% prevalence in adolescents to mid-20’s

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

Benign Breast Disease

By Symptoms

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

Nipple Discharge

Spontaneous, bloody, unilateral: malignancy Provoked, non-bloody, bilateral: benign Milky

Post-partum ↓ thyroid Pituitary tumour → prolactin Meds

OCP TCA’s

Nipple Discharge

Sticky Cystic changes Duct ectasia

Breast Mass

Mostly fibroadenoma ≥90% palpable breast masses 20’s to early

50’s are benign

Must exclude malignancy

Benign Breast Disease

Investigation

History

Physical Exam

Palpation of Mass

“Classic” findings in malignancy Single lesion Hard Immovable Irregular border Skin dimpling over lesion Size ≥2cm

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

Biopsy

Essentially any solid mass

Benign Breast Disease

Treatment

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

Simple Fibroadenoma

Several options Follow with US Core bx, then nothing further

Surgical excision not recommended Up-and-coming: US-guided cryoablation

Cyst

Aspiration Bloody fluid → cytology Non-bloody fluid → garbage

Follow-up US No recurrence → no further intervention Recurrence → surgical consult