Benign Solid Breast Masses

What is fibrocystic condition?

magnification of normal physiologic processes of breast tissue

The tissue in the fibrocystic condition is:

-very fibrous

-dense

-has many cysts

Fibrocystic Condition fluctuates with?

hormonal cycles

Fibrocystic Condition may _______ or _______ breast tumor

mimic or obscure

Fibrocystic Condition is typically a

bilateral process

What is the most common diagnosis at breast biospy?

fibrocystic condition

What are the clinical signs of fibrocystic condition?

-pain

-lumps or lumpy

What is the appearance of fibrocystic condition on mammogram?

-diffuse benign microcalcifications

-adenosis (breast glands are enlarged)

-multiple round masses

-very bright

What is the appearance of fibrocystic condition on Ultrasound?

-various appearances depending on stage

-multiple round masses/cysts

What is this image showing?

fibrocystic condition

What does fibrocystic condition look like microscopicly?

-apocrine metaplasia

-dilated acini

-fibrosis

-epithelial ductal hyperplasia (overgrowth of cells lining the breast)

-sclerosing adenosis (enlarged lobules)

Fibrocystic Condition and Breast Cancer Risk:

1. non-proliferative lesions

2. proliferative lesions without atypical cells

3. proliferative lesions with atypical cellular changes

What is the most common premenopausal benign tumor?

fibroadenoma (30%)

Fibroadenoma is

hormone dependent

What is the composition of fibroadenoma?

-connective

-epithelial

What is the appearance of a fibroadenoma on mammogram?

-radiopaque: brighter on xray/mammo

-oval or round mass

-circumscribed

-smooth margins

-may have lobulated contour or notching

-thin radiolucent halo

-eggshell calcification indicates older lesion

What is this image showing?

fibroadenoma on mammo

What is the sonographic appearance of an fibroadenoma?

-smooth walls

-oval to round

-lobulations

-homogeneous

-hypoechoic

-may enhance

-bilateral edge shadows

-horizontal

-slightly compressible

-mobile

What are theses images showing?

fibroadenoma on ultrasound

What is this image showing?

a giant fibroadenoma/juvenile fibroadenoma

What is a juvenile fibroadenoma?

-10-20 years old

-extremely large: 6-8 cm

-excision (remove them because cause discomfort

What is a lipoma?

fatty tumor

-encapsulated fat cells

What are the clinical signs of a lipoma?

mobile and palpable

What are the mammo features of a lipoma?

-radiolucent

-smooth margins

they blend in very well

What are the sonographic features of a lipoma?

-isoechoic

-smooth borders

difficult to see on ultrasound

What is this image showing?

lipoma

What is a hot, red breast mean?

inflammation or an infection

What is inflammation of the breast?

mastitis -inflammatory breast cancer

What are the treatments for mastitis?

antibiotics and imaging

What is the sonographic appearance of mastitis?

-dominant atypical cystic lesion

-possible ductal dilation

What is acute mastitis caused from?

-infection

-trauma

-ductal obstruction

What are the clinical signs of mastitis?

-enlarged

-reddened

-tender

-confined to 1 area

What are these images showing?

acute mastitis

What does chronic mastitis look like?

glandular tissue involvement

-mixed and diffuse echo pattern

-nipple discharge

-retracted/inverted nipple

Chronic Mastitis has what appearance on ultrasound?

heterogeneous

What are these images showing?

chronic mastitis 

Acute Abscess is

poorly defined

Mature abscess is

well encapsulated

What are the clinical signs and symptoms of an abscess?

-pain

-swelling

-reddening

What is this image showing?

a breast abscess

What is the sonographic appearance of an abscess?

-diffuse mottled appearance

-irregular margins

-posterior enhancement

-low level internal echoes

-skin thickening

-hyperemia

What are phyllodes?

rare <1% of breast neoplasms

-transitional

Phyllodes are transitional meaning?

they can turn malignant 27% malignant

What age group does phyllodes fall under?

50-60 years old

What are the clinical features of phyllodes?

rapid growth

What are the sonographic features of phyllodes

similar to fibroadenoma

What is this image showing?

phyllodes

What is a small benign tumor within the acini (ducts) of the breast?

intraductal papilloma

What is the age group of intraductal papilloma?

35-55 years old

What are symptoms of intraductal papilloma?

nipple discharge

What are the sonographic features of intraductal papilloma?

-ductal dilation 

-internal echoes

-blend in pretty well and are small

What is this image showing?

intraductal papilloma

What are traumatic changes of the breast?

-acute trauma

-post-surgical changes

-post-radiation changes

What are other benign findings of the breast?

lymph nodes and papilloma

What is common after surgeries and are caused by serum in tissues?

seroma

What are the sonographic features of a seroma?

fluid collection

septations

What is this image showing?

seroma

Post Surgical/Radiation Changes:

similar imaging appearance

different causes

-focal distortion

-irregular mass

should not have any blood flow within them

What is this image showing

a lumpectomy scar

What are benign breast tissue appear as?

displaced or compressed tissue

What does distorted breast tissue appear as

inflammation

post radiation

trauma

What is this image showing?

lumpectomy post radiation