Monday, March 13, 2017

Benign Breast Disease

This post is derived from notes I took during training. Any images are copyright their respective owners.

  • Simple cyst
    • Discard fluid after aspiration unless bloody (in which case, stop and send for cytology)
  • Fibrocystic change - may cause pain in menstruating woman, but essentially normal breast
  • Fibroadenoma - most common palpable mass in young women. Benign neoplasm. Can calcify
    • Giant form: greater than 8 cm
    • Tubular adenoma: variant form, lacks ca++. Circumscribed oval mass.
  • Hamartoma (fibroadenolipoma) - ‘breast within breast’ appearance. BIRADS 2.


  • Sclerosing adenosis - benign proliferative lesion caused by lobular hyperplasia, mimics DCIS
  • Mastitis
    • Nursing mothers or diabetics, presents with breast pain, induration, erythema.
    • Etiology: Most often S. aureus
    • Findings: diffuse skin thickening, edema, adenopathy
    • Treatment: antibiotics
  • Abscess
    • Typically due to S. aureus, can appear like mass
    • Treatment: antibiotics followed by US guided aspiration
  • Intraductal papilloma
    • most common cause of pathologic nipple discharge. 30-50 year old.
    • Benign tumor of lactiferous ducts.
    • Management: ductogram. An adequate ductogram relies on the presence of visible nipple discharge at the time of the procedure. If not seen, cancel and reschedule.
      • Look for filling defect within ducts
    • Treatment: Must excise because papillary carcinoma can appear identical on imaging
  • Periductal / plasma cell mastitis
    • Post menopausal women, due to irritation by intraductal lipids
    • DI: large, rod-like secretory ca++ (BIRADS 2)
  • Duct ectasia
    • A chemical mastitis, not pre-malignant
    • MG: ca++ can be rod-like or central lucencies due to ca++ forming around ducts (secretory ca++)
    • Prognosis: Not pre-malignant, do routine follow-up
  • Diabetic mastopathy
    • Long-term diabetics with firm, painful mass
    • Autoimmune reaction to matrix proteins from chronic hyperglycemia
    • MG: Asymmetry without ca++
    • US: hypoechoic mass
    • Treatment: Needs bx to exclude ca
  • Radial scar (complex sclerosing lesion)
    • MG: linear/radial spiculated appearance with hypolucent lesion
    • Differential diagnosis: carcinoma (dense center), post-surgical scar (not spiculated)
    • Treatment: resection because 30% pre-cancerous


  • Intramammary lymph node
    • Reniform with lucent / hyperechoic hilum, predominantly in upper outer breast
    • Unilateral axillary lymph nodes - exclude breast ca; bilateral enlarged, consider systemic prob
  • Pseudoangiomatous stromal hyperplasia (PASH)
    • Pathology: open slit-like spaces in dense collagenous stroma which are lined by a discontinuous layer of flat, spindle-shaped myofibroblasts with bland nuclei in hormonally active tissue
    • MG: benign mass up to 6cm with no ca++
    • Treatment/Prognosis: benign, but may recur after excisional biopsy
  • Mondor disease: breast superficial thrombophlebitis presenting as tender palpable cord, medial > lateral breast
  • Galactocele - younger pregnant/lactating women, well circumscribed rounded mass with possible fat-fluid level. No need for biopsy
  • Silicone Implants
    • On MR, radial folds extend to periphery, differentiating them from collapsed shell
    • Rupture
      • Intracapsular: MRI: multiple curvilinear low-signal intensity lines within silicone (linguine sign)
      • Extracapsular: US: “snowstorm” appearance of free silicone in breast or axilla (silicone granuloma)
  • Saline implants
    • If ruptured, breast shrinks and saline resorbed.
  • Gynecomastia
    • BIRADS 2 ductal proliferation, can be unilateral or bilateral
    • US: hypoechoic mass behind nipple with finger-like projections
    • MG: Flame-shaped
    • Differential: male breast cancer (lobulated borders, focal mass)
  • Male breast cancer - <1 all="" breast="" ca.="" of="">60s, presents with palpable mass.

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