Benign breast masses Flashcards
what are the general categories of benign breast masses?
- non-proliferative
- proliferative without atypia, RR 1.76
- hyperplasia with atypia, RR 3.96
increasing risk of malignant transformation
what are the three main non-proliferative breast conditions? how are they typically detected
- simple cyst
- mild hyperplasia
- papillary apocrine changes
cyst presentation varies from microscopic to clinically palpable
what proliferative without atypia conditions? how do they present?
- fibroadenoma: proliferation of epithelial and stormal components. clinically hard to distinguish from cyst. well circumscribed/mobile on exam
- sclerosing adenosis: increased # of glandular components in lobular units
- moderate/florid hyperplasia: ductal hyperplasia that fills entire duct
- radial scar: psuedoproliferative lesion on histology
- intra-ductal papilloma: tumor within lactiferous duct. central (more likely to have bloody nipple discharge) vs peripheral (usually bilateral, younger women)
Hyperplasia without atypia are typically excised. No chemoprophylaxis done.
types of atypical hyperplasia?
- atypical ductal hyperplasia
- atypical lobular hyperplasia
increased risk of cancer in that breast and contralateral breast
difference between LCIS and DCIS?
- DCIS is a pre-malignant lesion
- LCIS is not a pre-malignant lesion. But is a risk factor for future malignancy, either ductal or lobular. 10-20% in 15 years in either breast. RR of future cancer is 6.9-11
what is a phyllodes tumor, and how is it managed?
- benign fibroepithelial breast tumor
- does have risk of local recurrence, and occasionally sarcomatous distant mets
what is a tubular adenoma?
- tumor with benign glandular cells, minimal stromal elements
- appears solid on US; needs bx
what are categories of mastalgia? ddx for each?
- cyclical: related to hormones of menstrual cycle, contraception, fertility or AUB treatment
- non-cyclical: mastitis, thrombophlebitis, tumors, cancers
- extra-mammary: costochondritis, chest wall trauma, fibromyalgia, GERD, cervical radiculopathy, pregnancy
what are the main categories of inflammatory beast disorders?
- peuperal/mastitis
- non-pueperal
whats the ddx of non-peuperal inflammatory breast disorders?
- periductal/periareolar: typically younger women, after trauma. associated with smoking.
- peripheral: obvious cause. associated with immunocompromising, autoimmune conditions
- mammary duct ectasia: typically older women - can present with nipple discharge, non-cyclical pain, infection, nipple inversion
what is the ddx of breast skin changes?
- common derm conditions: eczema, psoariasis, contact dermatitis, yeast infections
- associated with underlying malignancy, particularly with Paget’s disease
what should the history for a breast related symptom include?
- thorough eval of presenting symptom
- risk factors for breast cancer
what is the difference in work-up of palpable mass of a under 30 vs 30 and over patient?
- under 30, first imaging is ultrasound
- 30 and over, first imaging is diagnostic mammography
- for both BIRADS 4-5 is bx
- for both BIRADS 3 is bx or close surveillance (exam + diagnostic mammo or US q6-12 m x 1-2 yrs)
- for both non-simple cysts should be aspirated or closely followed up
- for BIRADS 1, for 30+ high suspicion should be biopsied. for < 30 high suspicion should have diagnostic mammo f/u surveillance. For both, those being followed x 1-2 years (exam q3-6 mo, imaging q6-12 mo), if stable then normal surveillance. if growth, tissue bx
types of biopsy techniques- pros/cons
- fine needle biopsy: pro- inexpensive, minimally invasive. con - if atypia identified, additional bx needed.
- core needle biopsy: pro- minimally invasive, large bore needle, can leave clip
- excisional biopsy: pros- often needed with CNB results of high risk of malignancy
ddx of cystic mass of breast?
- ductal cyst
- fibrocystic change
- fibroadenoma
- hemorrhagic or trauma cyst/hematoma
- mastitis
- carcinoma
