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BENIGN MASSES IN BREAST ULTRASOUND. Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers. Benign Masses. Fibroadenoma Fibroadenoma variants : complex FA tubular adenoma, lactating adenoma Phylloides Tumor Hamartoma Lipoma Focal Fibrosis Diabetic mastopathy

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benign masses in breast ultrasound

BENIGN MASSES IN BREAST ULTRASOUND

Dr. Mona Rozin

Director of Breast Imaging

Assuta Medical Centers

benign masses
Benign Masses
  • Fibroadenoma
  • Fibroadenoma variants : complex FAtubular adenoma, lactating adenoma
  • Phylloides Tumor
  • Hamartoma
  • Lipoma
  • Focal Fibrosis
  • Diabetic mastopathy
  • Fibrocystic change
i fibroadenoma
I. Fibroadenoma
  • Arise from a single TDLU and contain both stromal (fibroma) & epithelial (adenoma) elements
  • Edge is “pushing” not infiltrating & becomes “encapsulated” by compressed breast tissue
  • FAs with cysts, apocrine metaplasia, or sclerosing adenosis are called COMPLEX
fa cont
FA – cont.
  • Peak incidence – 20-30 yr & again 40-50 yr
  • Usually 2-3 cm but giant FA & juvenile FA can grow to 10 cm
  • Estrogen stimulation is important so most common when unopposed (anovulatory) i.e.. in adolescence and perimenopause
  • Multiple in 25% also bilateral
fa sonographic appearance
FA – sonographic appearance
  • Oval, lobulated
  • Circumscribed with echogenic capsule
  • Parallel
  • Iso or hypoechoic
  • Normal or enhanced transmission with edge shadows
  • Tiny ones (<1cm) may be round & can’t DD from a complex cyst
  • May mimic duct extension
slide6

oval

lobulated

irregular

slide7

hypoechogenic

isoechogenic

slide9

Ca++

FA in pathology

fa cont1
FA – cont.
  • Wide variability in histologic composition
  • Wide variability in sonographic appearance
  • Bilateral multiple FAsup to 10 nodules in each breastno need to Bx all of themnew ones will almost always developneed 6 mo. F/U
ii fa variants complex fa
II. FA variants – Complex FA
  • The epithelial components undergo proliferative change and we may see:sclerosing adenosis, cysts, apocrine metaplasia, amorphous calcifications
  • About 20% of all FAs are complex !(-) FHx increases risk for CA 3x(+) FHx increases risk for CA 4x
  • Risk is generalized for the whole of both breasts.
ii fa variants complex fa1
II. FA variants – Complex FA
  • The diagnosis is histological
  • U/S: may see internal cysts or heterogeneous echo pattern
  • Seen at older age – median age 47 yrs
  • Only 1.5% contained a CA

AJR:2008;190:214-218

ii fa variants tubular adenoma lactating adenoma
II. FA variants – Tubular Adenoma & Lactating Adenoma
  • Almost pure epithelial growth with very little or NO stromal component
  • Tubular adenoma is very rare
  • Lactating adenoma is common during pregnancy (mainly 3rd trimester) and lactation
ii fa variants tubular adenoma lactating adenoma1
II. FA variants – Tubular Adenoma & Lactating Adenoma
  • Lactating adenoma may arise de novo, from a FA or from a tubular adenoma
  • U/S: oval, spindle shaped, parallel, hypo-hyperechoic, enhancement, Doppler (+), microlobulated
slide16

spindle shaped

microlobulated

Tubular adenomas

slide17

hypo

IDC-Grade 3

hyper

Lactating adenomas

iii phylloides tumor
III. Phylloides Tumor
  • Rare – peak at 40-50 yr but can occur in teenagers
  • Very rapid growth – up to 15 cm
  • 2/3 benign 1/3 malignant
  • Mix of very cellular stromal and epithelial elements
  • U/S: oval, well circumscribed, capsule, hypo, enhancement, “cystic slits”
iv hamartoma
IV. Hamartoma
  • Localized overgrowth of fibrous, epithelial and fatty elements = normal breast tissue
  • Other names: adenolipofibroma, lipoadenofibroma, fibroadenolipoma
  • U/S: oval, very heterogeneous, capsule, parallel
v lipoma
V. Lipoma
  • Overgrowth of fatty tissue
  • They are actually in the skin NOT in the breast
  • May grow up to 20 cm !!!!
  • U/S: completely isoechoic with the other fat lobules or mildly hyperechoic, soft and compressible
slide25

fat necrosis

hyper

iso

vi focal fibrosis
VI. Focal Fibrosis
  • FIBROUS MASTOPATHY
  • Can cause tender/non-tender palpable lump
  • May see focal asymmetry on mammo – UOQ
vi focal fibrosis1
VI. Focal Fibrosis
  • Pathology: dense stromal fibrous tissue without cells
  • U/S: purely hyperechoic & homogeneous, no capsule tapers into Cooper’s ligaments so can be teardrop or spindle shapedBEWARE: DD with echogenic rim !!!
vii diabetic mastopathy
VII. Diabetic Mastopathy
  • Occurs in premenopausal women
  • Most have Type I diabetes before the age of 20 yr
  • Usually a very hard palpable lump
  • May be multifocal, multicentric and bilateral
vii diabetic mastopathy1
VII. Diabetic Mastopathy
  • Mammo: non specific asymmetry
  • U/S: VERY SCARY !!!!!! Ill-defined, angular, microlobulated, hypoechoic, not parallel, intense shadowing
  • ALL go to Bx.
viii fibrocystic change
VIII. Fibrocystic Change
  • Huge spectrum from all the types of cystic change to benign proliferation forming a solid nodule
  • Adenosis & Sclerosing Adenosis:TDLUs enlarge and increase in numbernormal lobules – 2 mmadenosis – 5 mm
  • Mammo: focal asymmetry, masses, “starry night” calcifications
  • U/S: extremely varied
slide37

adenosis with amorphous ca++

adenosis with cysts

hypoechoic adenosis in hyper glandular tissue

slide39

adenosis

blunt duct adenosis

slide41

The faces of sclerosing adenois

central fibrosis

branching

distended terminal lobule

slide44
Remember algorithm and technique
  • Know your anatomy
  • Must correlate with mammo & clinical presentation
  • Huge overlap of findings
  • Better than doing mammograms all day!