Benign Breast Tumors and Related Diseases Flashcards
cysts appear to arise from
- Fluid Filled Cavity , lined by epithelium
- destruction and dilatation of lobules and terminal ductules.
- Fibrosis with Continued Secretion
Cyst influenced By
- Cysts are influenced by ovarian hormones
- Most cysts occur in women older than 35 years
- New cyst formation in older women is generally associated with exogenous HRT.
When to remove a cyst ? when to aspirate ?
- simple cyst without internal perturbation and smooth borders an aspiration is not necessary
- If the mass is complex, then aspiration may be necessary
- If the cyst resolves after aspiration and the cyst contents are not grossly bloody, the fluid does not need to be sent for cytologic analysis
- If the cyst recurs multiple times (more than twice is a reasonable rule), CNB should be performed to evaluate any solid elements
- The entire cystic structure can be percutaneously removed with a vacuum-assisted core needle device
when to consider surgical removal
> > Surgical removal of a cyst is usually not indicated but may be required if the cyst recurs multiple times or if needle biopsy reveals findings of atypia, incompletely removes the mass, or if the cyst is large and painful for the patient.
Fibroadenomas are composed of
stromal and epithelial elements.
fibroadenoma is the Mc or 2nd Most ?
> > Fibroadenoma is the second most common tumor in the breast (after carcinoma)
> > is the most common tumor in women younger than 30 years.
Fibroadenoma relation to the Cycle ?
wax and wane with the menstrual cycle
Risk of fibroadenoma to Cancer ?
- Cancer in a newly discovered fibroadenoma is exceedingly rare (0.2%); 50% of findings in fibroadenomas are LCIS »_space;
signifies a high risk for developing breast cancer, 35% are invasive carcinomas, and 15% are intraductal carcinoma.
Should you remove Fibroadenoma ?
Not needed
Unless»_space; patient is bothered by the mass or it continues to grow, the mass can be removed with open excisional biopsy or via percutaneous approach.
Two subtypes of fibroadenoma are
> > Giant fibroadenoma :
- large size (typically >5 cm).
> > Juvenile fibroadenoma :
- large fibroadenoma that occasionally occurs in adolescents and young adults and histologically is more cellular
Hamartomas and adenomas
- benign proliferations of variable amounts of epithelium and stromal supporting tissue
hamartoma
- Discrete nodule that contains packed lobules and ectatic extralobular ducts
- on exam and Mammo : indistinguishable from a fibroadenoma
adenoma or tubular adenoma
- a benign cellular neoplasm of ductules packed closely together so that they form a sheet of tiny glands without supporting stroma.
- During pregnancy and lactation :
they increase in size
Histology shows secretory differentiation
Two general categories of infections of the breast:
> > lactational infections
chronic subareolar infections associated with duct ectasia.
Infection of the breast most often caused by
Staphylococcus aureus
Tx of mastitis or Abscess
> > antibiotics and frequent emptying of the breast.
> > True abscesses require drainage.
> > Initial attempts at drainage should include needle aspiration
> > surgical incision and drainage should be reserved for abscesses that do not resolve after aspiration and treatment with antibiotics. In such cases, abscesses are generally multiloculated.
Women who are not Lactating ?
> > chronic relapsing infection may develop in the subareolar ducts
known as periductal mastitis or duct ectasia.
> > Associated with smoking and diabetes
mixed infections: aerobic and anaerobic skin flora
How do periductal mastitis or duct ectasia Present ?
> > A series of infections resulting in inflammatory changes and scarring Lead to retraction or inversion of the nipple, masses in the subareolar area, and chronic fistula from the subareolar ducts to the periareolar skin.
> > Palpable masses and mammographic changes may result from the infection and scarring
these can make surveillance for breast cancer more challenging.
Treatment ?
> > If subareolar pain and mild erythema :
- Warm soaks and oral antibiotics coverage for aerobic and anaerobic
> > If an abscess :
- needle aspiration + antibiotics.
Repeated infections are treated by
> > excision of the entire subareolar duct complex after the acute infection has resolved completely, together with intravenous antibiotic coverage
When to suspect Cancer ?
- A presumed infection of the breast generally clears promptly and completely with antibiotic therapy.
- If erythema or edema persists :
» a diagnosis of inflammatory carcinoma should be considered and biopsy of the skin as well as underlying breast tissue will be needed.
Solitary intraductal papillomas
- true polyps of epithelial-lined breast ducts
- often located close to the areola but may be present in peripheral
- smaller than 1 cm but can grow to 4 or 5 cm
- may appear to arise within a cystic structure
- benign tumor most associated with the development of DCIS
When Papillomas present with nipple blood ?
- located close to the nipple
> > Less frequently, they are discovered as a palpable mass under the areola or as a density seen on a mammogram.
Treatment of papillomas
> > Treatment is excision through a circumareolar incision.
> > For peripheral papillomas, the differential diagnosis is between papilloma and invasive papillary carcinoma
