Benign Breast Problems

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Benign Breast Problems
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Fibrocystic Changes Fibrocystic change is the most common cause of lumpy breasts. Small sacs of fluid build up at the end of the breast ducts and cause the lobule of the breast to enlarge and fill with fluid. This enlargement can occur throughout an entire branch of the breast duct system (Fig. 1), in only one area, or everywhere within the breast. The cause is usually either excess secretion of normal breast fluid, thickening of the breast fluid, or something blocking the breast duct near the nipple area. Thin fluid appears black on ultrasound images (Simple cyst Fig.2), while thicker fluid (apple juice like thin vs. apple sauce consistency thick) appears hazy or gray(Fig 3). Most of these problems appear normal or benign on mammograms.

Ultrasound Images, benign  conditions.

Fibroadenoma
A fibroadenoma of the breast is a solid lump of tissue that did not develop into normal breast tissue during adolescence. The breast tissue in the fibroadenoma did not develop the normal duct and gland tissue found elsewhere in the remainder of the breast, where nipple ducts branch out into multiple divisions ending in the milk production sacs called lobules. The fibroadenoma instead traps the ducts and milk sacs in a thick scar-like tissue called fibrosis. These lumps can be quite firm and often form in adolescents, but may be discovered at any age.

Ultrasound images (Fig. 5) of the fibroadenoma show uniform interior gray dense tissue, a well defined outline and a well outlined capsule edge. Usually there are only a few curves or lobulations in its outline. Pathologic examination shows pink colored fibrous tissue and compressed ducts (Fig. 6). These benign lesions may be followed by routine examination if they are not painful or do not grow. If they have any suspicious characteristics they should be biopsied by needle biopsy, or removed in some instances.

Hyperplasia
Hyperplasia is the overgrowth of normal cells in either the ducts or lobules of the breast (see Fig. 1). Hyperplastic cells appear larger than normal cells, but do not have an irregular shape or internal appearance. Hyperplasia is usually called Ductal Hyperplasia or Lobular hyperplasia depending on where the cells are located along the branches of the breast duct and lobule tree. Images below show these changes as seen in the microscope.

Papilloma
A papilloma of the breast is a growth within a breast duct growing out of the wall of the breast duct. These may cause nipple discharge or bloody discharge. A well defined papilloma can often be seen by ultrasound in the ducts near the nipple. If they are identified by biopsy, they should be completely removed, because of their proliferative potential.

Papillomatosis is a generalized change of the lining of the breast duct that commonly causes calcifications on mammography. Papillomatosis is benign and usually does not lead to long term problems. This is typically a diagnosis seen at the time of needle biopsy for microcalcification of the breast seen by mammography.