4. Breast p128-129 (Benign Diseases)

Question 1

Mondor disease (4)

Answer 1

Thrombosed vein presenting as tender palpable cord.
Looks like thrombosed vessel on US.
Not a DVT, doesn’t need anticoag.
Rx: NSAIDs and warm compress.

Question 2

Fat containing lesions (5)

Answer 2

5 classic causes, all are benign.
- Hamartoma
- Galactocele
- Lymph node
- Lipoma
- Oil cyst/fat necrosis
Only last 2 are consudered pure fat containing lesions

Question 3

Hamartoma (2)

Answer 3

“breast within a breast”. Difficult to see on US as they blend into breast tissue

Question 4

Galactocele (2)

Answer 4

Young lactating women, usually on cessation of lactation.
Usually subareolar, varied appearance, but can have fat-fluid level.

Question 5

Oil cyst/fat necrosis (4)

Answer 5

Areas of fat necrosis walled off by fibrous tissue.
Seen randomly, post trauma or post surgery.
Peripheral calcifications pattern is usually egg shell.
Lots of them may suggest Steatocystoma Multiplex.

Question 6

Lipoma (2)

Answer 6

Usually radiolucent with no calcifications.
Enlargement of a lipoma is a criteria for biopsy.

Question 7

Intramammary lymph node (2)

Answer 7

Normal, typically located in tissue along pectoral muscle, often close to vessels.
NOT seen in fibroglandular tissue.

Question 8

When to US (3)

Answer 8

Usually palpable finding will get US, and under 30s will mostly skip mammography.
One exception is a fat containing lesion is a definate benign finding on diagnostic mammography

Question 9

Pseudoaneurysmal Stromal Hyperplasia (PASH) (4)

Answer 9

Benign myofibroblastic hyperplastic process.
Usually a big (4-6cm) solid, oval shaped lesion with well defined borders.
Can be seen between 18-50 years old.
Usually recommend annual follow up.

Question 10

Fibroadenoma (4)

Answer 10

Commonest palpable mass in young women.
Usually oval, circumscribed mass with homogenous, hyopechoic echotexture and central hyperechoic band.
If shown in an older patient, more likely to have course, popcorn calcifications.
MRI: T2 bright with type 1 enhancement (progressive)

Question 11

Phylloides (5)

Answer 11

10% risk of malignant degeneration.
Can metastasize, usually haematogenous to the lungs and bone.
Fast growing breast mass.
Need wide margins on resection, higher recurrence if margin <2cm.
Occurs in older age than fibroadenomas (40s-50s).
Biopsy of sentinel node is not needed, as mets to lymphatics are rare.

Question 12

Distinguishing features of Phylodes tumour (4)

Answer 12

Rapid growth.
Haematogenous mets
Middle age to older women
Mimics a fibroadenoma