Benign Breast Diseases
Nur Fajri Rahmi (G99172128)
Neoniza Eralusi Asrini (G99172127)
Zhafirah Ramadhanty (G991902063)
DEFINITION
• Benign breast tumor is a mass of abnormal breast’s tissue.
• these tumors are not generally aggressive toward surrounding tissue,
occasionally they may continue to grow, pressing on organs and
causing pain or other problem.
• Benign breast tumor usually have smooth edges and can be moved
slightly when you push against them.
EPIDEMIOLOGY
Type of Tumor Epidemiology
Fibroadenoma Most common breast mass in women
< 35 years old.
Peak incidence : 15-35 years
Phyllodes tumor Rare (<1% of all breast tumors)
Peak incidence : 40-50 years
Intraductal papiloma Peak incidence
Solitary lession : 48 years
Multiple lession : 41 years
ETIOLOGY
• The etiology of benign breast tumor is mostly unknown.
• there are a hormonal relantionship has been established. The
increasing of estrogen in pregnancy or before menstruation make the
abnormal proliferation of breast tissue.
RISK FACTOR
• Age at menopause
Age at menopause may possibly be related to fibrocystic breast disease
but not to fibroadenoma. reported the relative risks to be 1.4 and 3.0
for ages at menopause of 49-51 and >52 years, respectively, relative to
ages at menopause of <49 years (p for trend = 0.0005)
RISK FACTOR
• Nulliparity
Nulliparous women may be at increased risk of fibrocystic breast
disease but not of fibroadenoma with confidence interval (CI) 1.4-3.6
• Family history of breast cancer
There are found a relative risk of 2.8 (95 percent CI 1.5-5.3) for
fibrocystic breast disease for a history of breast cancer in a mother or a
sister of the case.
RISK FACTOR
• Obesity
obesity had the strongest and most consistent association with both
fibroadenoma and fibrocystic breast disease.
obesity was defined in a variety of ways, e.g., according to current or
past body mass index (kg/m2), highest-ever body mass index, weight,
skinfold thickness, and breast size.
THE DIFFERENCE
Features Benign Malignant
Growing Slow growing Fast growing
Capsulated Yes Non capsulated
Invasive Non invasive Invasive & infiltrate
Metastasis Non Yes
Shape Smooth/ oval/ Nodular/ stellate/
lobulated/ reguler irreguler
The pains Painful Painless
Skin No skin dimpling Skin dimpling
Nipple No nipple retraction Nipple retraction
Prognosis Good Bad
Damage to human Relatively smaller Relatively bigger
body
Classification
• Non Proliferative lesion of the breast
• Cysts
• Fibroadenoma
• Proliferative lesion without atypia
• Papillomatosis
• Sclerosing adenosis
• Radial and complexing sclerosing lesions
• Proliferative lesion with atypia
• Atypical lobular hyperplasia
• Atypical ductal hyperplasia
Non Proliferative Lesion
Breast Cyst Fibroadenoma
Proliverative lesion without atypia
• Papillomatosis
• Sclerosing adenosis
• Radial and complexing sclerosing
lesion
Proliverative lesion with atypia
• Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia
(ALH)
• Mimic LCIS and DCIS
• Often found accidentally in mammography
• Increased risk for breast cancer
Clinical Manifestation
• Mastalgia/breast pain
• Nipple discharge
• Dominant masses and discreet lumps
DIAGNOSIS
• A detailed history and
physical exam systematically
evaluates the entire breast
and chest wall and focuses on
areas involving the patient’s
symptoms.
Diagnosic Studies
For lumps, “The Triple Test” is recommended which includes:
1. Palpation
2. Imaging (mammography, often in conjunction with ultrasound
examination)
3. Percutaneous biopsy (either core or fine needle aspirate).
Mammography
Purpose:
1. To find lesions while they are still small
2. To localize lesions for a subsequent stereotactic biopsy
3. To help clinician classifying the detected lesions as benign or
malignant
Benign breast tumor
Normal breast
Malignant breast tumor
MRI
• To localize primary occult lesions in patients with axillary metastases.
• To determine the extent of tumor involvement in the ipsilateral breast
and evaluate the contralateral breast in patients with proven cancer.
• To monitor the response to neoadjuvant chemotherapy.
• To screen patients with BRC1 or BRC2 mutations.
• To rule out cancer in patients who have an indeterminate physical
examination, mammography, or ultrasound.
BIOPSY
Core Needle Biopsy Fine needle aspiration (FNA) biopsy
• Core needle biopsy is used under • thin (25-gauge) needles were
ultrasound, mammographic, or inserted and an area was sampled
MRI guidance to remove solid under the guidance of either
cylinders of tissue, using a palpation or ultrasound. The
relatively wide (10- to 14-gauge) needle attached to a syringe is
hollow needle attached to a tissue used to withdraw (aspirate) a small
sampling device. The device may amount of tissue from a suspicious
be spring-loaded or vacuum area. FNAB reduced scarring and
suction assisted, or it may employ a the trauma of a biopsy, but often
cryo-assisted core gun. failed to obtain enough tissue for
an unequivocal diagnosis
TREATMENT
1. Surgical excision
• Surgical excision is the definitive procedure performed for
symptomatic benign breast tumors regarding potential for growth or
malignancy as well as physical discomfort.
• Currently, the accepted definitive treatment of surgical excision
results in scar formation and potential for keloids, as well as breast
volume loss and potential for nipple areolar distortion or
displacement
Minimally invasive technique
• Endoscopic breast surgical techniques demonstrate technique
mastery of breast tissue removal with small axillary incisions.
• Vacuum-assisted breast biopsy procedure involves ultrasound or
stereotactic-guided percutaneous insertion of an 8-gauge or 11-gauge
needle probe device, and the breast tissue is aspirated by vacuum
suction. The incision is small (3-4 mm).
• Cryoablation destroys breast lesions in situ, avoids breast tissue
volume defects and potential breast distortion. The pathophysiology
of cryotherapy involves disruption of the cellular membrane of gland
cells both near and far away from the probe, as well as capillaries,
resulting in thrombosis and hypoxia of the target lesion
NEOADJUVANT CHEMOTHERAPY
• Showed histologic changes such as lobular atrophy, decreased
cellularity, and increased fibrosis occurring in normal glandular tissue
• Affects the endothelial lining of the vessels leading to loss of vascular
support. Similar changes may be expected to be seen in benign
lesions leading to decreased enhancement.
Risk factors for breast cancer
• Particularly high for proliferative lesions, especially those with atypia
• Family history of breast cancers lightly modified the association
between low-risk histologic diagnosis and breast cancer development
• Women with high breast density and proliferative lesions with atypia
were at highest risk for future breast cancer
