BENIGN BREAST

TUMORS
 BENIGN TUMORS OF BREAST
A swelling or lump produced in any part of the body due to
abnormal growth of tissue is known as a tumor. A growth that is
found within the breast tissue is known as a breast tumor. It may be
non-cancerous (benign) or cancerous (malignant).

Most tumors of the breast are found to be non-cancerous.

Nevertheless a thorough investigation is necessary to rule out

malignancy.
 A. FIBROADENOMA

INTRODUCTION
A fibroadenoma is a smooth, discrete breast lump consisting of
fibrous and adenomatous
(glandular tissue). It is firm
and mobile that it appears to
shift position and is commonly
referred to as a “breast mice”.
Fibroadenomas are the second most common solid tumor after
breast cancer and most common benign tumor in women.
It is the most common breast tumor in young women usually
under the age 30 years of age and growth may be associated
during pregnancy.
Painless, firm, solitary, mobile, slowly
growing breast mass. It can cause
drastic asymmetrical growth of the
breast.
Usually detected when it is 2 or 3 cm in
size.
CAUSES
The cause of fibroadenoma is unknown (idiopathic).
A connection between fibroadenomas and reproductive
hormones during reproductive years, increase in size during
pregnancy, and regress post-menopause.
Giant Fibroadenoma
Uncommon variant (4%) of fibroadenoma
characterized by rapid growth.
Peak incidence occurs in late adolescence.
Size of lesions is usually more than 5 cm.
The underlying mass may cause a major distortion to the breast
tumor.
 CLINICAL FEATURES
The typical presentation is in a reproductive age with a palpable
breast lump.
Painless swelling, smooth, firm
Commonly enlarges during pregnancy and involve at menopause.
The lesions are well defined and well circumscribed.
The lesions are not fixed to the surrounding parenchyma and slip
around under the palpating hand, hence the colloquial term a
breast mouse.
INVESTIGATIONS
Mammogram – Appear as oval or round soft tissue densities with
smooth or lobulated margins.
•Usually have very well-defined borders and may exhibit the halo
sign, in which a thin dark border is seen under the edge of the mass.
•Macrocalcification can be seen (popcorn appearance).
Ultrasound – An oval shaped, well-defined nodule with uniform
internal echo pattern.
FNAC
MANAGEMENT
1. Lumpectomy
Periaroelar or submammary incision (for big lump) is preferred.
Usually GA is used but small lump can excised under local
anesthesia. Incision is deepened until capsule of mass.
Enucleation technique: In case of pericanalicular type, capsule is
incised and mass is removed with a finger which is pushed into the
cleavage between the capsule of mass.
The lump is sent for histological examination.
2. Cryoablation
A small needle is placed in the tumor centre under USG guidance
(local anesthesia). The tip of needle is freezed and thus ice crystal
formed inside of lump can be seen on USG. This procedure is done
on a outpatient basis.

3. Percutaneous suctioning
It is ultrasound guided placement of 12 gauge ATEC needle and
suction of tumor under local anesthesia.
B. PAPILLOMA
Intraductal papillomas are a benign breast lesion that usually occur
in females in their 40-50yrs, most typically occurring in
the subareolar region (usually less than 1cm away from the nipple).
They will often present with bloody or clear nipple discharge, yet
larger papillomas can also present initially as a mass.
They can appear similar to ductal carcinomas on imaging and
therefore usually require biopsy. Some cases may be excised to ensure
no atypical cells or neoplasia are present. Risk of breast cancer is only
increased with multi-ductal papilloma and most are treated
with microdochectomy.
C. Lipoma
A breast lipoma is a soft and mobile benign adipose tumor that
are normally otherwise asymptomatic. They have low malignant
potential and are usually only removed if they are significantly
enlarging or causing symptomatic.
D. Phyllode Tumors
Phyllode tumors are rare fibroepithelial tumors. Phyllodes tumors are
commonly larger, occur in an older age group, and are comprised
of both epithelial and stromal tissue. They often grow rapidly.
They are difficult to clinically and microscopically differentiate from
fibroadenomas, however around one third of Phyllode tumors
have malignant potential and 10% of benign tumors will recur after
excision.
Consequently, most Phyllode tumors should be widely excised (or
mastectomy if the lesion is large).