Benign Breast Findings

General

  • Benign things requiring no follow up

    • Fibroadenoma

    • Lipoma

    • Hamartoma

    • PASH

    • Intramammary lymph node

    • Fat necrosis

    • Fibcrocystic changes/cysts

  • Benign findings that still warrant surgical evaluation

    • Phyllodes tumor

    • Granular cellt umor

    • Desmoid Tumor

    • Granulomatois mastitis

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

Granular Cell Tumor

  • Rare benign mass arising from Schwann cells

  • Typically arise medially from the supraclavicular nerve

  • Looks like a mass, therefore needs biopsy

  • Rarely malignant

  • Treated with wide local excision

Fibrocystic Changes

  • Basically catch all term for crunchy breasts, including

    • Cysts

      • Microscopic cysts may have milk of calcium

    • Apocrine metaplasia

      • Transformation of normal breast cells to apocrine sweat glands - benign, normal process

    • Fibrosis

    • Sometimes calcifications

  • No follow up needed

Granulomatous Mastitis

  • Idiopathic inflammation of breast

  • Pre-menopausal women

  • Classically occurs within a few months of a recent/last regnancy

  • Seen usually as subtle focal asymmetry with indistinct margins

  • Present with

    • Galactorrhea

    • Pain

    • Skin chnages

    • Possible palpable mass

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 - means degenerating

  • if > 5 cm = giant fibroadenoma

  • If grows > 20% in 6 months —> need biopsy to exclude phyllodes

  • MR findings

    • T2 bright

    • T1 post

      • Homogenous

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

      • Do not always enhance

Phyllodes tumor

  • Basically a fibroadenoma that grows too much and is in older women (50+)

    • Also reoccur more than fibroadenoma

  • Tend to be large on presentation, > 5 cm

  • Middle to older women

  • Homogenously hypoechoic, well circumscribed mass on US

    • If large, may have internal cystic components

  • Classified into

    • Benign

    • Borderline

    • Malignant (25% of cases are malignant)

    • All of these are treated with wide local excision even if benign

  • ~20% of malignant phyllodes will metastasize, hematogenously to

    • Liver

    • Lung

    • Bone

Breast Hamartoma

  • Dense, focally disorganized but normal breast tissue with internal areas of fat

  • So called “breast within a breast” appearance

  • Not well seen on US

  • No biopsy if classic features

  • No increased risk of cancer

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

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

  • Mimics vascular lesions - hence pseudo-angiomatosis

  • Usually large (4-6 cm)

  • Solid, oval shaped mass with well defined borders

  • Typically no calcifications

  • Need to biopsy these because could be a huge fucking mass and you’re the idiot who said not do because could be PASH

Desmoid Tumor

  • Rare, benign but locally aggressive mass

  • Mass from proliferation of fibroblasts/myofibroblasts

  • Present as hard, palpable mass

  • Associated with prior injury

  • Associated with Gardner syndrome & FAP

  • Treated with wide local excision, sometimes with radiation

    • Recur in 1/3 of cases but do not metastasize

Benign Non-Mass Breast Changes

Other, Seemingly not so important benign breast changes?

  • Stromal fibrosis

    • Benign stromal proliferation that obliterates the ducts and acini

    • Causes fibrotic tissue with little fat in between

    • Can look like anything on mammo and needs biopsy

    • Seems more like a path thing that rads thing tbh

  • Usual ductal hyperplasia

    • Benign proliferation of ductal epithelial cells but cells look normal where as atypical ductal hyperplasia cells look atypical

    • No increased risk, no surgery intervention, again prob path thing not so much for rads

Diabetic Mastopathy

  • Autoimmune reaction to glycosylated proteins

  • Present as a hard mass

  • Commonly associated with Type-1-DM

  • Commonly recurs and may worsen with excision, so leave it alone after diagnosis

Gold Therapy

  • Basically punctate calcs in a LN

  • Old treatment for RA

Lipoma

  • Isoechoic (bright) to fat on US

  • No need for biopsy