Benign Breast Disease

Question 1

Fibroadenoma

Answer 1

• AKA ‘breast mouse’ as they are small and mobile
• Benign tumours of stromal/epithelial breast duct tissue
• Common in younger patients <40 years
• Smooth, well circumscribed, firm, mobile lump
• Usually up to 3cm
• Hormone dependent and regress after menopause

Question 2

Fibrocystic breast disease (fibroadenosis)

Answer 2

• Common in women of menstruating age
• Related to hormonal changes around menstrual cycle
• Symptoms often occur prior to menstruating (within 10 days) and resolve after wards
• Benign condition, although can vary in severity and have an effect on quality of life if severe
• Usually resolves after menopause
• Symptoms
  
  • Bilateral breast lumpiness
  • Bilateral breast pain/tenderness (mastalgia)
  • Fluctuation of breast size
• Treatment
  
  • Supportive Clothing
  • NSAIDs
  • Weight Loss
  • Hormonal contraception may make it worse (consider stopping)

Question 3

Breast cysts

Answer 3

• A discrete collection of fluid in the breast tissue
• Most common between ages 30-60.
• A smooth, well circumscribed, mobile, possibly fluctuant lump
• Benign
• Can fluctuate in size over the menstrual cycle
• Treat conservatively, with needle aspiration or local excision

Question 4

Breast abscess

Answer 4

• An acute (usually bacterial) infection of the breast tissue
• May be associated with fever, pus discharge from the nipple and local erythema, tenderness and heat
• Treat with antibiotics.
• May require incision and drainage surgically.

Question 5

Fat necrosis

Answer 5

• A lump formed by local degeneration/scarring of fat tissue
• This is an inflammatory reaction resulting in fibrosis and eventually necrosis
• Commonly caused by local trauma or breast surgery
• A firm, irregular, fixed lump that may cause skin dimpling or nipple inversion.
• Radiologically similar appearance to breast cancer
• Can be associated with an oil cyst, containing emulsified fat
• Benign condition
• May resolve spontaneously
• Treat conservatively or with surgical excision

Question 6

Lipoma

Answer 6

• A benign collection of fat
• A soft, painless and mobile lump up to 20cm in size
• Benign
• Treat conservatively with reassurance or with surgical excision

Question 7

Phyllodes tumour

Answer 7

• Large, fast growing periductal stromal cell neoplasm.
• Most common between age 40-50.
• Can be benign (~50%), borderline (~25%) or malignant (~25%)
• 1% of breast neoplasms.
• Requires local excision.

Question 8

Mammary duct ectasia

Answer 8

• Benign
• Smoking is a major risk factor
• Nipple discharge, often blood stained
• Mastalgia (non-cyclical)
• Nipple inversion/retraction
• Occasional associated with a palpable subareolar mass
• Treat conservatively and it often settles spontaneously
• If persists surgical excision is an option

Question 9

Intraductal papilloma

Answer 9

• Usually present around the post menopause
• Can present with a serous or bloody discharge from the nipple
• Small (2-3mm) wart like lesion within a breast duct
• They can obstruct the duct causing cysts or twist and become necrotic causing bleeding
• Investigate with breast ductography (injection of contrast to visualise the breast ductal system)
• Benign but can represent and increase risk of cancer
• Treated mostly with surgical excision and vigilant breast screening