Chapter 19: Benign Breast Lesions

Question 1

Patient presents with pain, swelling and redness of the breast during the postpartum period.
What is the diagnosis? What is the most likely cause? What will help it resolve?

Answer 1

Diagnosis = Acute Mastitis
Cause = Staphylococcus or Streptococcus infection
Treatment = Continued lactation or antibiotics

Question 2

Patient presents with a hard mass in their breast, a biopsy demonstrates hemorrhage, cholesterol clefts and acute inflammation.
What is the diagnosis? What would likely be in the history that the patient may have neglected to tell you?

Answer 2

Diagnosis = Fat necrosis
History = Trauma

Question 3

Multifocal, bilateral, nodularities within the breast occasionally associated with pain in a reproductive age woman.
What is the diagnosis? What would the histology likely show?

Answer 3

Diagnosis = Fibrocystic non-proliferative breast changes
Histology = Fibrofatty tissue with multiple "Blue Dome" cysts, aprocine cells with eosinophilic cytoplasm

Question 4

A mobile, painless, well defined breast lump in a reproductive age Afro-caribbean woman. On ultrasound the lesion is an oval sharply demarcated from surrounding breast tissue. The biopsy shows a spindle cell stroma with normal epithelial components.
What is the diagnosis? What risk of malignancy?

Answer 4

Diagnosis = Fibroadenoma
Risk = Doubled (according to the Q&A book and Uptodate, Rubins does not agree and says there is NO increased risk)

Question 5

The patient described above decided to not have her fibroadenoma removed, she returns 2 years later concerned that the mass seems to have grow dramatically in the past few months. What is the likely cause of this change?

Answer 5

Pregnancy will induce rapid growth the fibroadeoma since the tumor is hormonally driven.

(note: Menopause will bring about the end of growth in most cases)

Question 6

Name the 4 proliferative breast diseases. What is the cancer risk associated with these conditions?

Answer 6

Usual epithelial hyperplasia, Sclerosing adenosis, Radial scar, and Intraductal papilloma

2-3x risk of cancer

Question 7

A 60 year old woman discovers a rapidly growing breast mass, the ultrasound demonstrates a well circumscribed mass. Pathology after its removal shows a gray-white firm mass with hypercellularity, abundant mitoses, and a leaf like growth pattern.
What is the diagnosis?

Answer 7

Malignant phyllodes tumor