BENIGN BREAST DISEASE Flashcards
What are the commonly seen causes of benign breast lesions or lumps?
Fibroadenoma
Fibroadenosis / fibrocystic breast disease
Sclerosing adenosis
Breast cysts
Epithelial hyperplasia
Fat necrosis
Duct papilloma
Mammary duct ectasia
What are fibroadenomas?
Tumours of stromal and epithelial tissue that arise in the terminal duct lobular unit of the breast
What is the lay term sometimes used to describe fibroadenomas of the breast?
Breast mice - due to their mobility
What are the risk factors for developing fibroadenomas of the breast?
15-25 years old
Black race
What are the clinical features of fibroadenomas?
Highly mobile
Firm
Non-tender
Usually under 3 cm
Usually solitary
Slow growing
What percentage of all breast masses do fibroadenomas make up?
12%
What is the increase in risk of malignancy with fibroadenomas?
None - they are not pre-cancerous
What percentage of fibroadenomas will regress in size over 2 years?
30%
How do we manage a painless, highly mobile breast lump suggestive of fibroadenoma?
Imaging to confirm diagnosis
If more than 3 cm can be surgically resected
What age group are most commonly affected by fibroadenosis or fibrocystic breast disease?
Middle age, pre-menopausal
Affect 50% of women of child bearing age
What are the clinical features of fibrocystic breast disease?
Lumpy / cobblestone texture to breasts
Pain which is often periodically related to menstrual cycle
May be tender breasts
May be itchy
Are fibrocystic breast lesions pre-cancerous?
No, however, they may increase risk of morbidity and mortality from breast cancer by inhibiting more cancerous lumps from being detected
How do we manage a lady with a periodically painful breast lumps suggestive of fibrocystic breast disease?
Triple assessment to rule out cancer
Treated on a symptomatic basis with NSAIDs, but Danazol and Tamoxifen may be used to block oestrogen input into cyclical pain.
Closer follow up may be required to make sure no cancerous lumps are being missed.
What are the clinical features of sclerosing adenosis?
Multiple lumps
Small
Firm
Painful
Cause mammographic changes that may mimic carcinoma
Are sclerosing adenosis breast lesions pre-cancerous?
They are part of a group of diseases that fall under the heading of borderline breast disease:
“group of conditions while being not completely malignant are still concerning”
How do we manage a lady who presents with multiple small painful lumps in her breast suggestive of sclerosing adenosis?
Triple assessment - need biopsy to exclude malignant potential
Excision is not mandatory
What percentage of Western women will present with a breast cyst?
7%
What are the clinical features of breast cysts?
Smooth lump
Discrete
Fluctuant
Often come on very quickly
Are breast cysts pre-cancerous?
They can be. More likely to be malignant if found in younger patients.
How do we manage a lady who presents with smooth discrete fluctuant lumps suggestive of cysts?
Triple assessment
Cysts should be aspirated - those which are blood stained or persistently refill should be biopsied or excised.
What is epithelial hyperplasia of the breast?
Increase in number of the cells in the lining of the ducts (ductal hyperplasia) or lobules (lobular hyperplasia) in the breast.
What are the clinical features of ductal or lobular hyperplasia?
Variable presentation
Sometimes generalised lumpiness
Sometimes discrete lumps
Often asymptomatic and picked up on mammogram screening
Is ductal or lobular hyperplasia of the breast pre-cancerous?
Those found to have atypical features on histology can be
How do we manage a lady who is found to have ductal or lobular hyperplasia?
Triple assessment
Those found to have atypical features should have close monitoring or excision
