Benign conditions of the breast

Question 1

Describe the layers of the glandular tissue and ducts

Answer 1

• 2 layers
• Inner luminal layer (that secretes milk)
• Outer myoepithelial layer (that is contractile under oxytocin and allows for the mobilisation of milk)

Question 2

State the developmental abnormalities of the breast

Answer 2

• Ectopic breast tissue
• Breast hypoplasia
• Stromal overgrowth (juvenile hypertrophy and gestational hypertrophy)
• Breast assymetry
• Nipple inversion

Question 3

What is stromal overgrowth

Answer 3

• Leads to excessive breast size
• Can be uncomfortable and cause body image issues
• Can occur during puberty (juvenile hypertrophy) or during pregnancy (gestational hypertrophy)

Question 4

Why can stromal overgrowth be difficult to manage?

Answer 4

Because if you do a breast reduction the process may continue so the breast grows in size again

Question 5

Nipple inversion

Answer 5

• Common and most likely normal if not new

* If it is new and/or unilateral then it is more likely to be associated with a benign or malignant condition

Question 6

What is acute mastitis?

Answer 6

A cellulitis associated with breast feeding

Question 7

How does acute mastitis occur?

Answer 7

• Skin fissuring from breast feeding
• May let bacteria in
• Milk stasis favours the growth of the bacteria
• Infection of the breast tissue
• May be abscess

Question 8

How is acute mastitis treated?

Answer 8

If there is an abscess then incision and drainage, and antibiotics

Question 9

When can granulomatous inflammation of the breast tissue occur?

Answer 9

In systemic diseases
•Sarcoidosis
•Tuberculosis (rare)

Question 10

What is idiopathic granulomatous mastitis?

Answer 10

Lobule centred non-necrotising granulomatous inflammatory process with a tendency to reoccur after incision (it may respond to steroids but need to be sure it isn’t an infection)

Question 11

Foreign body reactions in the breast

Answer 11

• Foreign body reactions can arise to breast implants
• Can lead to capsular contractures causing discomfort and distortion of the breast
• Reactions can occur to silicone leakage after implant rupture

Question 12

what is recurrent subareolar abscess associated with?

Answer 12

• Mamillary fistula
• Squamous metaplasia of lactiferous ducts
• Smoking

Question 13

What is periductal mastitis?

Answer 13

• Dilation of the central lactiferous ducts
• Periductal chronic inflammation
• Scarring

Question 14

What are the signs of periductal mastitis?

Answer 14

• Often asymptomatic
• A mass
• Nipple retraction or inversion
• Discomfort
• Calcified luminal secretions on a mammogram

Question 15

when is periductal mastitis most common?

Answer 15

In middle age

Question 16

What is periductal mastitis associated with?

Answer 16

Smoking

Question 17

What is fat necrosis?

Answer 17

Follows trauma, is benign but a core biopsy may be required to rule out cancer

Question 18

What is fibrocystic change?

Answer 18

• Spectrum of change
• Small/ large cysts, increased amounts of glandular tissue
• increased fibrous stroma
• epithelial hyperplasia of usual type or with atypia
• solitary papillomas, papillomatosis and radial scars are also part of the wider spectrum of fibrocystic change

Question 19

Describe the risk of cancer with fibrocystic change

Answer 19

• non proliferative = no excess risk of subsequent breast cancer
• proliferative without atypia = 2-fold excess risk of breast cancer
• Proliferative with atypia = 5 fold risk, or more if positive family history

Question 20

What is adenosis in the breast?

Answer 20

Increase in the glandular breast cancer

Question 21

What is sclerosis adenosis?

Answer 21

Benign proliferation of the distorted glandular tissue and stroma

Question 22

How is apocrine metaplasia recognised?

Answer 22

• Large, rounded epithelial cells
• Copious, granular eosinophilic cytoplasm
• Characteristic apical projections

Question 22

How is apocrine metaplasia recognised?

Answer 22

• Large, rounded epithelial cells
• Copious, granular eosinophilic cytoplasm
• Characteristic apical projections

Question 23

What is apocrine metaplasia associated with?

Answer 23

Fibrocystic change

Question 24

What are the differences between atypical lobular hyperplasia and lobular carcinoma?

Answer 24

The extent and the amount of cellular proliferation

Question 25

What are radial scars?

Answer 25

Benign lesions characterised by a fibrotic core with elastic fibres, trapped glands and a pseudo-infiltrative appearance

Question 26

What is an intraduct papilloma?

Answer 26

Benign tumour of the epithelium lining in the mammary ducts

Question 27

What are the different patterns of epithelial hyperplasia?

Answer 27

• Ductal

* Lobular

Question 28

What is atypical ductal hyperplasia?

Answer 28

• Features in common with low grade ductal carcinoma in situ
• Associated with micro calcifications

Question 29

When are columnar cell lesions detected?

Answer 29

• Mammography

* Associated with microcalcifications

Question 30

Describe diabetic fibrous mastopathy

Answer 30

• Stromal fibrosis with infiltrating lymphocytes, may present with a hard mass
• Associated with type 1 diabetes

Question 31

What is pseudo-angiomatous stromal hyperplasia?

Answer 31

Proliferation of myofibroblasts may cause a mass

Question 32

Phyllodes tumour

Answer 32

• Epithelium and mesenchyme
• Cellular stroma with mitotic activity, cytological atypia and an infiltrative border
• Requires surgical excision with a margin of normal breast tissue

Question 33

What benign condition can mimic paget’s disease?

Answer 33

Nipple adenoma