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• Define and identify benign breast conditions
• Identify the symptoms of benign breast
conditions
• Identify the correlation of benign breast
conditions and the risk of breast cancer
• Demonstrate the diagnosis of benign breast
conditions
Objectives
Benign Breast Conditions
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Benign Breast Conditions
Definition of Benign Breast Disease
Benign breast conditions (also known as
benign breast diseases) are non-cancerous
disorders or changes in the breast. There are
a variety of benign breast conditions.
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Benign Breast Conditions
Symptoms
• Benign breast conditions are not life-
threatening, but can cause bothersome
symptoms such as a lump or nipple
discharge.
• Certain benign conditions are linked with a
higher risk of developing breast cancer in
the future.
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Benign Breast Conditions
Cysts
• Small fluid-filled sacs found in the breast
• Most commonly found in premenopausal women
• Do not increase the risk of developing breast cancer
• May be felt by patient if large enough, otherwise seen
using mammography and breast ultrasound
• Cause of cysts are unknown
• No necessary follow-up unless causing discomfort to
the patient
• Cyst aspiration is a treatment option
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Benign Breast Conditions
Case Study
• 39 y/o presents with right breast lump in the UOQ
• Tenderness at site of lump x 1 month
• No discharge or inversion of nipple
• 3D mammogram demonstrates a 1.7 cm oval-shaped nodule
• There is also a possible 1.2 cm oval-shaped nodule present in
the subareolar region demonstrated on the MLO view
• No obvious spiculation
• >75% density
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Benign Breast Conditions
Ultrasound
Ultrasound demonstrates a simple cyst in the 10-11:00
position, 6 cmfn. It measures 2.7 x 1.5 x 2.5 cm. Several
smaller cysts are seen within its immediate vicinity
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Benign Breast Conditions
Fibroadenomas
• Fibroadenomas are benign tumors
• They are most common in younger women (between the
ages of 15 and 35)
• Most fibroadenomas do not increase the risk of breast
cancer
• If a fibroadenoma causes discomfort, it may be excised
• Blood flow may be present
• Often followed using ultrasound every six months (up to 1
to 2 years) to track any change in size
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Benign Breast Conditions
Case Study
• 23 y.o. female
• Right palpable mobile lump
• Measures 2.3 x 1.2 x 1.6 cm
• Lobulated homogeneous solid mass
• Blood flow present
• Followed over a sixth month period with no
significant change in size
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Benign Breast Conditions
Case Study
• 40 y.o. female
• 0.7 x 1 x 1.3 cm hypoechoic mass
• Right breast; 7:00 position
• Moderate suspicion for malignancy
• U/S of right breast demonstrates a well-circumscribed
macrolobulated hypoechoic lesion
• No shadowing present
• Given the solid appearance, biopsy recommended
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Benign Breast Conditions
Biopsy Results
• Patient underwent ultrasound-guided core biopsy
• Pathology findings confirm a benign fibroadenoma
• Six month follow-up ultrasound recommended to
look for any post-procedure changes
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Benign Breast Conditions
Hyperplasia
• High rate of mitosis or overgrowth (proliferation)
of cells
• Most often occurs on the inside of the lobules
(milk ducts) in the breast
• Two types of hyperplasia
• Typical (Usual)
• Atypical
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Benign Breast Conditions
• 50 y.o. female
• Presents with 5 day history of spontaneous
bloody discharge; left breast
• No breast lump or skin changes
• Mild diffused breast pain
• Physical exam demonstrated blood coming from a
single duct at the 3:00 position
Case Study
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Benign Breast Conditions
Ultrasound-Guided Biopsy
• Subareolar ultrasound demonstrates
slightly prominent ducts with no debris
• Fairly well circumscribed hypoechoic lesion
is seen measuring 9x4 mm
• No shadowing, but of solid nature
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Benign Breast Conditions
Pathology
• Ultrasound-guided biopsy was performed
and sent to pathology
• Indication: Hypoechoic lesion
• Pathologic diagnosis: Atypical ductal
hyperplasia
• Recommended follow-up: Excision of area
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Benign Breast Conditions
ADH
• Classification between TDH and ADH is dependent on
histological features
• High reproducibility is important classification
• Typical cells appear heterogeneous and atypical are
homogeneous in cell type
• ADH is more related to DCIS than typical
• ADH is rare and seen in approx. 4% of symptomatic benign
biopsies
• ADH is more commonly linked to sreen-detected benign calcs
(31%) and is more commonly an incidental finding
• Patients are at a 4-5x higher risk of developing BrCA with a h/o
ADH
• Risk is even higher if patient has a first degree relative with BrCA
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Benign Breast Conditions
ADH
Three components to the diagnosis of ADH:
1. Pattern
2. Cytology
3. Disease Extent
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Benign Breast Conditions
Intraductal Papillomas
• Small growths that occur in the lobules
• Can cause nipple discharge
• Sometimes presents as a lump
• Most commonly seen in women 35-55 years old
• May be removed by a breast surgeon
• No follow-up necessary
• Does not increase a woman’s risk of developing
breast cancer
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Benign Breast Conditions
Case Study
• 51 y.o. female
• Perimenopasual
• Presents with bloody discharge from the right
nipple
• Physical examination revealed no evidence of
lumps, asymmetry or dimpling of the skin
• Small amount of bloody fluid appeared when
pressure was exerted on the nipple
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Benign Breast Conditions
Ultrasound
demonstrates a
solid mass
measuring 2.45 mm
within a dilated
duct
Ultrasound
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Benign Breast Conditions
Recommendation
• After reviewing the negative mammogram from six
months prior, immediate surgical consultation was
recommended
• Mass was excised
• Histological examination revealed it was benign
(intraductal papilloma, central)
• Following excision, all of the patient's symptoms
disappeared
• No follow-up required
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Benign Breast Conditions
Sclerosing Adenosis
• A group of small breast lumps caused by enlarged lobules
• A lump may be felt and may be painful
• Can be found mammographically
• May be mistaken for breast cancer due to its shape and feel
• A biopsy is often necessary to rule out breast cancer
• Sclerosing adenosis does not need medical treatment
• This can be found alongside an existing or developing cancer
and/or atypical hyperplasia
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Benign Breast Conditions
Case Study
• 40 y.o. female
• Presents with right breast lump at 6:00
• Imaging also shows amorphous calcifications
• U/S guided biopsy recommended
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Benign Breast Conditions
Biopsy Results
• Right stereo core biopsy preformed at 6:00
• Results show proliferative fibrocystic disease with cellular
change and focal sclerosing adenosis
• Calcifications look to be benign; repeat magnification
views in six months
• Microscopic descriptions in addition to above
demonstrates typical ductal hyperplasia and intraductal
cells and cysts
• 6 month f/u recommended
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Benign Breast Conditions
Case Study
• 50 y.o. female
• Cluster of pleomorphic calcifications seen on the
CC and MLO views
• Left UOQ of breast
• Due to irregular borders, biopsy recommended
• Stereo-core biopsy
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Benign Breast Conditions
Biopsy Results
• Pathology demonstrates non-proliferative
fibrocystic disease
• Rare benign focus suggesting early sclerosing
adenosis
• Calcifications present in benign ducts
• Findings are concordant with imaging features
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Benign Breast Conditions
Radial Scars (Also known as complex
sclerosing lesions)
• Made up of connective tissue fibers from which milk
ducts and lobules grow from
• Present similar to breast cancer on a mammogram, but
they are not cancer
• Because of their appearance on imaging, they are often
biopsied and excised
• After they are removed, no further treatment is necessary
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Benign Breast Conditions
Case Study
• 40 y.o. female presented to the breast clinic with a
history of irregular nodularity in the right breast
• Serous nipple discharge x 5 months
• Physical examination demonstrates a firm nodularity
in right breast
• Mammographically, the nodule measures 0.7 cm
• Radiating spicules noted
• No calcifications or architectural distortion was
appreciated
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Benign Breast Conditions
Biopsy and Diagnosis
• Patient underwent an ultrasound-guided fine needle
aspiration
• Sample of the material was insufficient for a definitive
diagnosis
• A lumpectomy was performed on the patient as the
mammography was suggestive of a radial scar
• Lumpectomy specimen revealed a firm stellate area of
about 0.6 cm
• Microscopically, the lesion had a central fibroelastotic core
with radiating tubules characteristic of a radial scar
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Benign Breast Conditions
Galactocele
• Most common benign breast lesion
• Typically occurs in young lactating women
• Is also referred to as a lactocele
• Presents with a painless breast lump occurring over weeks to
months
• Can present as a single or multiple nodule(s)
• Unilateral or bilateral
• Diagnosis can be done with an aspiration
• Most likely located near the sub-areolar region
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Benign Breast Conditions
Case Study
• Presents with lump x 2 weeks
• Patient currently breast feeding
• No pain
• No skin changes
• Physical exam of lump demonstrates a firm and mobile lesion
• Ultrasound demonstrates a well-circumscribed hyperechoic
lesion
• Mild shadowing
• Mild doppler flow
• Ultrasound-guided biopsy recommended
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Benign Breast Conditions
• Ultrasound appearances can be widely
variable
• Sonographic characteristics according to
one study is as follows:
• cystic / multicystic: ~ 50%
• mixed (cystic + solid): ~ 37%
• solid: ~ 13%
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Benign Breast Conditions
Biopsy Results
Benign breast tissue with lactational change and
features consistent with galactocle
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Benign Breast Conditions
Lipoma
• Slow growing, fatty lump
• Are mobile and “squishy” to the touch
• Are not usually tender
• Most commonly found in middle age
• Some people have more than one at a time
• Lipomas are most often harmless and go untreated
• If the lipoma is bothersome, painful or growing, patient
may have it removed
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Benign Breast Conditions
Case Study
• 40 y.o. female
• Density seen on baseline mammogram
• Right UOQ
• Persists with spot compression views
• Ultrasound recommended
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Benign Breast Conditions
Ultrasound and Ultrasound-guided
biopsy
• Ultrasound demonstrates a circumscribed almost
completely isoechoic lesion
• Lesion measures 2.2 x 1.3 cm
• Biopsy recommended
• Ultrasound- guided biopsy performed
• Biopsy results demonstrate a fatty benign lesion; lipoma
• Six month follow-up recommended
• Patient did not undergo surgery or treatment
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Benign Breast Conditions
Lobular Carcinoma (LCIS)
• An area or areas of abnormal cellular growth
• Increases a person’s risk of developing invasive breast cancer later
on in life
• Lobular means that the abnormal cells start growing in the lobules,
the milk-producing glands at the end of breast ducts
• Carcinoma refers to any cancer that begins in the skin or other
tissues that cover internal organs — such as breast tissue
• In situ or “in its original place” means that the abnormal growth
remains inside the lobule and does not spread to surrounding
tissues
• Diagnosis of LCIS tends to have more than one lobule affected
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Benign Breast Conditions
LCIS
Despite the fact that its name includes the term
“carcinoma,” LCIS is not a true breast cancer.
LCIS is an indication that a person is at higher-than-
average risk for getting breast cancer at some point
in the future.
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Benign Breast Conditions
Case Study
• 48 y/o
• Mammographic findings demonstrate a
small group of calcifications in the upper
outer posterior right breast
• Magnification views recommended
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Benign Breast Conditions
Mammographic Findings
• Calcifications appear to be new compared to prior studies
• Indeterminate
• BIRADS 4: Suspicious findings
• Stereotactic scout attempted
• Breast tissue measures too thin for stereotactic biopsy
• Patent was referred for a surgical specimen
• Needle localization recommended and undertaken
• Specimen reveals LCIS and area is excised
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Benign Breast Conditions
Phyllodes Tumor
• Rare breast tumors that, like fibroadenomas, contain 2 types of breast
tissue: stromal (connective) tissue and glandular (lobule and duct)
tissue
• Most commonly found in women in their 30s and 40s, but they may be
found in women of any age
Link to cancer risk
• Not usually cancerous, but in rare cases they may be related
• One third of these tumors are classified as malignant based on how
they look under the microscope, less than 5% of phyllodes tumors
overall are clearly true cancers
• Can reappear; close follow-up with frequent breast exams and imaging
is usually recommended after treatment
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Benign Breast Conditions
Diagnosis
• Tumors are usually felt as a painless lump, but may be painful
• Capable of growing quickly and can stretch the skin
• Difficult to differentiate from fibroadenomas on imaging tests and by
biopsy
• Often the tumor needs to be removed to prove it is a phyllodes tumor
• Microscopically the main difference between phyllodes tumors and
fibroadenomas is the overgrowth of connective tissue
• Cells that make up the connective tissue part can look abnormal under
the microscope
• Histology classifies tumors dependent on the cellular makeup;
phyllodes tumors may be classified as benign (non-cancerous),
malignant (cancerous), or borderline (looking more abnormal than
benign tumors, but not quite malignant)
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Benign Breast conditions
Case Study
• 48 y/o female
• Presents with large lump in the medial aspect of the left
breast
• Ultrasound images of the breast demonstrate large
heterogenous mass of 5.6 x 3.4 cm
• Contains multiple lobulations and cystic spaces
• The appearance of the tumor is “leaf-like” in its internal
architecture
• There is also posterior acoustic enhancement
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Benign Breast Conditions
Ultrasound Images
• The images show minimal internal vascularity on color
Doppler ultrasound
• Internal lobulation with typical leaf like pattern on
sonography
• Age of the patient, large size of tumor and typical
ultrasound features are highly suggestive of this being a
Phyllodes tumor of the left breast
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Benign Breast Conditions
Treatment
• Phyllodes tumors (even benign ones) can re-grow in the same place if
they are removed without taking enough of the normal tissue around
them
• Treated by removing the tumor and at least a 1 cm (a little less than ½
inch) area of normal breast tissue around the tumor
• Malignant phyllodes tumors are treated by removing them along with a
wider margin of normal tissue, or by mastectomy if necessary
• Malignant phyllodes tumors are different from the more common types
of BrCA
• They do not respond to hormone therapy and are less likely than most
breast cancers to respond to RT or chemo
• Phyllodes tumors that have spread to distant areas are often treated
more like sarcomas (soft-tissue cancers) than breast cancers
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Benign Breast Conditions
References
American Cancer Society (2014). Non-cancerous breast conditions. Retrieved December 19, 2014 from
http://www.cancer.org/healthy/findcancerearly/womenshealth/non-cancerousbreastconditions/non-cancerous-breast-
conditions-intro
Bortolotto, C., & Canepari, E., & Tarallo, V. (2012). Intraductal papilloma of the breast: A case report. Retrieved March 3,
2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558092/
Breastcancer.org (2015). LCIS-Lobular carcinoma in situ. Retrieved February 3, 2015 from
http://www.breastcancer.org/symptoms/types/lcis
Department of Radiation Oncology, Tata Memorial Hospital (2009). Secretory carcinoma arising in radial scars of the
breast: A case report and review of literature. Retrieved March 2, 2015 from
http://www.ijpmonline.org/article.asp?issn=0377-
4929;year=2009;volume=52;issue=1;spage=83;epage=85;aulast=Menon
Mayo Clinic (2014). Atypical Hyperplasia of the breast. Retrieved December 19, 2014 from
http://www.mayoclinic.org/diseases-conditions/atypical-hyperplasia/basics/definition/CON-20032601
Pinder, S. E., & Ellis, I. O. (2003). The diagnosis and management of pre-invasive breast disease DCIS and ADH- current
definitions and classification. University of Nottingham. Retrieved April 1, 2015.
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Benign Breast Conditions
References
Radiopaedia.org (2015). Galactocele. Retrieved January 29, 2015 from http://radiopaedia.org/articles/galactocele
Susan G. Komen (2014). Benign breast conditions. Retrieved December, 19, 2014 from
http://ww5.komen.org/BreastCancer/BenignConditions.html
