Benign tumours

Question 1

List the different types of benign breast tumours.

Answer 1

• Fibroadenoma
• Adenoma
• Papilloma
• Lipoma
• Phyllodes tumour

Question 2

What is the most common benign growth in the breast?

Answer 2

Fibroadenoma

Question 3

At what age are fibroadenomas most likely to present?

Answer 3

Usually occurs in women of a reproductive age

Question 4

What is the pathophysiology of fibroadenoma?

Answer 4

Forms due to proliferations of stromal and epithelial tissue of the duct lobules.

Question 5

What do you find on examination of fibroadenoma?

Answer 5

• Highly mobile lesions (termed “breast mouse”)
  
  • Well-defined & rubbery on palpation
  • Most less than 5cm in diameter
  • Can be multiple and bilateral.

Question 6

What is the management of fibroadenoma?

Answer 6

1. Monitoring (over 2 year period)
   * Very low malignant potential
2. Excision
   * Indication for potential excision are > 3cm in diameter or patient preference.

Question 7

What is an adenoma?

Answer 7

Benign glandular tumour, typically occurring in the older female population. The lesions themselves are nodular and can easily mimic malignancy, therefore most cases will undergo escalation for triple assessment.

Question 8

What are intraductal papillomas?

Answer 8

Benign breast lesion that usually occur in females in their 40-50yrs, most typically occurring in the subareolar region (usually less than 1cm away from the nipple).

Question 9

How do intraductal papillomas present?

Answer 9

• Bloody or clear nipple discharge
• Mass (with larger papillomas)

Question 10

How are intraductal papillomas typically managed?

Answer 10

1. Biopsy
   * Can appear similar to ductal carcinomas on imaging
2. Excision (Microdochectomy)
   * To ensure no atypical cells or neoplasia are present.

Question 11

How does intraductal papilloma affect the risk of breast cancer?

Answer 11

Risk of breast cancer is only increased with multi-ductal papilloma

Question 12

1. What is a breast lipoma?
2. What is their malignant potential?
3. What is the indication for removal of breast lipomas?

Answer 12

1. A soft and mobile benign adipose tumour that are normally otherwise asymptomatic.
2. Low malignant potential.
3. Removed if they are significantly enlarging or causing symptomatic compressive or aesthetic issues.

Question 13

What are Pyllodes tumours?

Answer 13

Rare fibroepithelial tumours that are larger, occur in an older age group, and are comprised of both epithelial and stromal tissue. They often grow rapidly.

Question 14

How are Phyllodes tumours diagnosed & managed?

Answer 14

Difficult to clinically and microscopically differentiate from fibroadenomas

Management

1. Wide excision because:

• 1/3 have malignant potential
• 10% of benign tumours will recur after excision. Consequently, most

2. Mastectomy (if the lesion is large).

Question 15

What is the typical presentation of benign breast tumours compared to malignant tumours?

Answer 15

Variety of presentations but in general:

Presentation of benign breast tumours:

• Smoother borders
• Mobile
• Multiple lesions

Presentation of malignant tumours:

• Craggy surfaces
• Firm consistency
• Fixed
• Single mass

Question 16

What are the most important differentials to consider when a patient presents with a breast lump?

Answer 16

• Cysts
• Abscesses
• Malignant lesions

Question 17

How should breast lesions be investigated?

Answer 17

1. Triple assessment (All suspicious breast lesions)
   * Includes examination, imaging, and histology.

Question 18

How should confirmed benign breast lumps be managed?

Answer 18

1. Reassurance & routine check ups
   * In most cases / subtypes
2. Excision

• If breast lump can’t be confirmed as benign or has malignant potential with atypical cells.
• Also if symptomatic (painful/discomfort) and growing