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Benign Breast DiseasesBy: Ismah Haron & Hamidah Aziz

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Part 1: Outline

•Fibroadenosis/fibrocystic disease•Fibroadenoma•Giant fibroadenoma•Phyllodes tumor •Traumatic fat necrosis

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Case 1•Madam Z, 40 y/o presented with multiple

lumps at right breast that associated with cyclical pain. PE revealed soft and fluctuated lumps.

•Fibroadenosis/fibrocystic disease

•Triple assessment

•Reassurance, cyst aspiration, hormone manipulation e.g. COC pill

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http://www.ultrasound-images.com/breast.htm

Hypoechoic, well defined mass with a few anechoic spaces

Fibroadenosis: localized fibrosis, inflammation, cyst formation and hormone driven breast pain (15-55 y/o)

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•If aspirated fluid is blood stained or cyst recur many times core biopsy or local excision

•Exclude cystadenocarcinoma

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Case 2• Miss Y, 22 y/o presented with a small painless mobile

lump at right breast that not increased in size. She is otherwise well. PE revealed fixed, firm, well defined margin, freely mobile breast lump.

• Fibroademona

• Triple assessment

• Treatment depends on its size<3 cm: reassurance>3 cm: excision

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http://medicalcenter.osu.edu

Fibroadenoma: benign overgrowth of lobule of the breast (common: <30 y/o)

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Ultrasonogram demonstrates a hypoechoic mass, well defined

margin

Craniocaudal mammograms demonstrate a mass in the outer

part of the breast

http://emedicine.medscape.com/article/345779-overview

2 cm

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Giant fibroadenoma

Ultrasound images of the left breast in a 15 y/o girl show a large (the mass measured 8.2 cms.),

hypoechoic and well defined mass

http://www.ultrasound-images.com/breast.htm

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•Occasionally during puberty•>5 cm in diameter•Rapidly growing•Excision•Potential for malignancy is low

Povoski World Journal of Surgical Oncology 2007 5:124http://www.indianpediatrics.net/jan2005/jan-

72.htm

Enlarged right breast due to fibroadenoma

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Case 3

•Miss X, 48 y/o admitted with small breast lump had been present over many years and had started to enlarge in the last 3 months. The lump is mobile.

•She was single and nulliparous but without a family history of breast cancer

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• Right breast showing a large fleshy tumour protruding from the lower outer quadrant with most of the remaining breast also containing tumour.

• The surrounding skin although bluish is not oedematous

• A large heterogeneous mass of 5.6 x 3.4 cm with multiple lobulations and cystic spaces also present.

• The appearance of the tumour was leaf like in its internal architecture

http://casereports.bmj.com

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•Diagnosis: Phyllodes tumor

▫Rare breast tumor that forms from the connective tissue of the breast.

▫Benign, malignant or borderline by histological

▫Surgical removal Benign:- removing the mass and a 2 cm area of

normal breast tissue from around the tumor. Malignant:- removed with a wider margin of

breast tissue or by total mastectomy if needed

2cm

Tumor

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Traumatic fat necrosis▫Fibrosis▫Local hematoma/bruising▫Calcification

•New, painless/painful breast lump•Poorly defined margin lump•History of trauma•Triple assessment•Resolved spontaneously, excision biopsy

http://www.makemeheal.com

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Summary

P. Youssefi, et al. Mind Maps in Surgery

Benign breast disease (part 1)

• Middle age, > 40 y/o• Slow growing, smooth, large, big

enough to cause skin necrosis, unevenly surface

• Potentially malignant• Rx : surgical removal

Phyllodes tumor

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Thank youOther references:1. Bailey & Love’s Short Practice of Surgery 25th

edition2. Oxford Handbook of Clinical Surgery 3rd edition