Benign Breast Disorders
FIBROCYSTIC CHANGES
The earlier term fibrocystic disease has little clinical value, and the term was abandoned by the College of American Pathologists in 1985. Lesions formerly grouped together under the designation of fibrocystic disease represent a pathologically heterogeneous group of diseases that can be divided into three separate
histologic categories: nonproliferative lesions, proliferative lesions (hyperplasia) without atypia, and atypical hyperplasias.
HYPERPLASIA
Hyperplasia is the most common benign breast disorder and is present in about 50% of women. Histologically, the hyperplastic changes may involve any or all of the breast tissues (lobular epithelium, ductal
epithelium, and connective tissue). When the hyperplastic changes are associated with cellular atypia,
there is an increased risk for subsequent malignant transformation.
It is postulated that the hyperplastic changes are caused by a relative or absolute decrease in production
of progesterone or an increase in the amount of estrogen. Estrogen promotes the growth of mammary
ducts and the periductal stroma, whereas progesterone is responsible for the development of lobular and
alveolar structures. Patients with hyperplasia improve dramatically during pregnancy and lactation because of the large amount of progesterone produced by the corpus luteum and placenta and the increased production
of estriol, which blocks the hyperplastic changes produced by estradiol and estrone.
The disorder usually occurs in the premenopausal years. Clinically, the lesions are usually multiple and
bilateral and are characterized by pain and tenderness,particularly premenstrually.
Treatment depends on the age of the patient, the severity of the symptoms, and the relative risk for the development of breast cancer. Women older than 25 years should undergo baseline mammography to
exclude carcinoma. Cysts may be aspirated to relieve pain . If the fluid is clear and the lump disappears,
careful follow-up only is indicated. Open biopsy is required if the fluid is bloody or if there is any residual mass following aspiration.
FIBROADENOMA
Composed of both fibrous and glandular tissue, the fibroadenoma is the most common benign tumor found
in the female breast. Clinically these tumors are sharply circumscribed, freely mobile nodules that may occur
at any age but are common before the age of 30 years. They usually are solitary and generally are removed
when they reach 2 to 4 cm in diameter, although giant forms up to 15 cm in diameter occasionally occur and
have malignant potential. Pregnancy may stimulate their growth, and regression and calcification usually
eventuate postmenopausally. These larger tumors require surgical excision for definitive diagnosis and
cure.
INTRADUCTAL PAPILLOMA
Papillary neoplastic growths may develop within the ducts of the breast, most commonly just before or during menopause. They are rarely palpable and are usually diagnosed because of a bloody, serous, or turbid discharge from the nipple. Mammography and cytologic examination of the fluid are helpful in investigating nipple discharge. Excisional biopsy of the lesion and involved duct is the treatment of choice.
Histologically there is a spectrum of lesions ranging from those that are clearly benign to those that area naplasticand give evidence of invasive tendencies.
GALACTOCELE
A galactocele is a cystic dilation of a duct that is filled with thick, inspissated, milky fluid. It presents during
or shortly after lactation and implies some cause for ductal obstruction, such as inflammation, hyperplasia,
or neoplasia. Often multiple cysts are present. Secondary infection may produce areas of acute mastitis or abscess formation. Needle aspiration is usually curative.
If the fluid is bloody or the mass does not disappear
completely, excisional biopsy is required.
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