Benign Breast Findings

Dermal Calcifications

  • Clustered calcs that are about same size and shape and do not change on CC & MLO views

  • Tend to be near folds (i.e. axilla)

  • Can get a tangential view to prove they are dermal calcs

Secretory Calcifications

  • Rod like/cigar shaped calcifications with a dash-dash pattern

  • Calcs point toward nipple

  • Typically bilateral

  • Seen in older women 10-20 years after menopause because it is from duct involution

Fibroadenoma

  • Round well circumscribed mass with central scar

  • Largely hypoechoic with hyper-echoic central scar

  • Mass in pre-menopausal woman (estrogen dependent)

  • If seen in an older person it will have bulky popcorn calcs, with increased calcs in it over time

  • MR findings

    • T2 bright

    • T1 post

      • Homogenous

      • Thin non-enhancing septa (Type 1 enhancement pattern)

      • Do not always enhance

Phyllodes tumor

  • Middle to older women

  • Basically same appearance as fibroadenoma but in older patient (50+)

  • Homogenously hypoechoic , well circumscribed mass on US

  • Not benign

  • Need wide margin resection

Breast Hamartoma

  • Dense breast mass with internal areas of fat density

  • So called “breast within a breast” appearance

  • Not well seen on US

Fat Necrosis/Oil cyst

  • Eggshell looking thing with low density centrally

  • Prior trauma (surgery, true trauma)

Multiple Bilateral Masses

  • 3+ masses bilaterally

  • Technically benign, idk not explained well

References:

Fat Containing Lesions (5) = benign = BR-2

Milk of Calcium

  • Round calcs on CC that flatten on MLO

  • Get an ML view to prove, will really flatten out

  • Caused by dilated lobules in fibrocystic changes

  • BR-2 that shit

  • If you biopsy it and do not see calcs

    • Need to use polarized light to assess birefringence to see them

Phyllodes tumor

  • Clustered/grouped round calcifications

    • Baseline - BR3

    • New from prior -BR4

Mondor’s

  • Tubular looking thing

  • May have some doppler flow

  • Tender palpable cord

  • This is a thrombosed superficial vein

  • No need for AC

Galactocele

  • Subareolar

  • Fluid-fluid level on US

  • Only seen in lactating patient

  • Do not biopsy - can cause milk fistula

Lymph Nodes

  • Commonly in posterior third of breast

Pseudoangiomatosis Stromal Hyperplasia (PASH)

  • Benign myofibroblastic hyperplastic process

  • Usually large (4-6 cm)

  • Solid, oval shaped mass with well defined borders

Gold Therapy

  • Basically punctate calcs in a LN

  • Old treatment for RA

Lipoma

  • Isoechoic to fat on US