Benign breast diseases

Dr Maryam Tabatabaeian

Benign breast lesions

  Non proliferative no risk for malignancy cysts,fcc without hyperplasia,epithalial calcifications,apocrine papillary changes, Proliferative without atypia 1/5-2 × risk Ductal hyperplasia,papilloma,sclerosing adenosis,radial scar,fibroadenoma  Proliferative with atypia 3/7-5/3 × risk ADH,ALH

Fibroadenoma B3

Single or multiple(FH) Most masses in women<30yrs Size>3cm,age>35yrs,FH+,growth rate>30% in 3 months biposy or excision if patients is stressed Giant fibradenoma>5cm benign 17%regression without therapy Macrolobulation is normal microlobulation needs biopsy Complex fibradenoma surgery

Cysts

 Simple cyst B2 thin wall,single or multiple,clear content,size<3cm no risk ,routine follow up  Complicated cyst B3 thick wall<5mm,septation,internal echo,no flow in doppler sono 0/4% malignancy hematoma,absess,fat necrosis,galactocele  Complex cyst B4 Thick wall>5mm,size>5cm,mass component,shadow absses,apocrine metaplasia,oil cyst,fat necrosis,malignancy 20-40% malignant

Mass

    <30 yrs mostly benign 75%fibroadenoma >50 yrs half malignant <30yrs sonogram >35 yrs mammogram   BIRADS 3 without riskfactor follow up BIRADS 4 or B3 with risk factor biopsy  Biopsy CNB

Mass

 Mammogram 20% false negative 40- 50 yrs 10% false negative>50 yrs After a negative biopsy follow up each 6 months to 2 yrs is mandatory

Thickening

2 dimentional lesion Mammogramm and sonogram and other complementary test as indicated 10-17% need biopsy 50% of biopsies are malignant no need to medical treatment

Papilloma

is benign but needs surgery because of nipple bleeding Papillomatosis malignancy : .5 papilloma in one segment no risk for

ADH,ALH

  Gail model for risk assesment No OC or HRT  Flat epithelial hyperplasia exscision, less risk for malignansy

hamartoma

 Fibroadenolipoma malignant tranformation sugery

Adenoma

Pure epithelial component,tubular and lactating subtype No risk for malignancy Surgery in suspicious forms

Granulomatous mastitis

non TB granulomatosis Presents as mastitis or inflamation and mass Dx CNB Treatment :treatment of absses and then corticosteroids in refractore cases Surgery has malconvinient results and deformities cause to unnecessary mastectomies