Benign Lesions of the Breast

Benign lesions of the breast are the third most common disorder of the breast after cancer and fibrocystic disease. Spreading is not typical for these lesions. Their likelihood of recurrences is low after surgery. Fibroadenoma, intraductal papilloma, and phyllodes tumors are the most common benign lesions of the breast.

Fibroadenoma

It is the most common mass lesion in the breast. Although it can be seen at any age, it is most common at ages from 20 to 30 years. Fibroadenomas are characterized by mobile and soft lesions with regular margins and they are 2-3 cm in diameter. They are usually painless. Fibroadenomas can sometimes grow excessively and called giant fibroadenomas. These lesions are sensitive to hormonal changes and may undergo changes during pregnancy. Fibroadenomas may regress during menopause.

In the literature, it is generally accepted that fibroadenomas do not transform into cancer. The patient presents with a painless mass. Mammography and especially ultrasonography in young individuals are necessary for the diagnosis. Fibroadenomas are identified as homogeneous and well-circumscribed lesions with smooth margins in USG. FNA or trucut biopsy may be necessary for a definitive diagnosis. They are recommended to be performed in suspected cases and in patients at advanced ages.

There is no medical treatment for fibroadenoma. Fibroadenomas can be managed by regular follow-ups if they evoke no clinical suspicions and if the result of the FNA biopsy is in favor of fibroadenoma. These lesions can be removed with surgery if there are structural irregularities or suspected findings or surgery can be performed based on patients’ preferences.

Phyllodes Tumors of the Breast

Phyllodes tumors of the breast are rare lesions, accounting for less than 1% of all primary breast tumors and 2-3% of all fibroepithelial tumors. Phyllodes tumors are usually seen in women at ages from 35 to 55 years. Although they resemble benign fibroadenomas, they are distinguished from fibroadenomas by increased cellularity in the histological examination and local recurrences and metastatic spread clinically. According to the World Health Organization classification, there are 3 types of phyllodes tumors that are benign, borderline, and malignant. Malignant phyllodes tumors account for almost 25% of all phyllodes. The main treatment for these types of tumors is surgery.

They are clinically manifested as rapidly growing masses. In some patients, a long-term existing mass starts growing rapidly. No specific mammography, USG or MR findings have been established yet to distinguish giant fibroadenomas from phyllodes tumor. Trucut biopsy may help make the diagnosis.

Surgical intervention is the main treatment for phyllodes tumors. Preoperative diagnosis is very important to plan surgery appropriately.

Surgery is necessary for the treatment of phyllodes tumors. A wide surgical excision (at least with a diameter of 1 cm) is recommended to achieve negative surgical margins regardless of the histopathological type.

Intraductal Papilloma

Intraductal papilloma are small benign tumors originating from a lactiferous duct in the breast. It is most commonly seen in women at ages from 35 to 55 years. These tumors are classified into central and peripheral types. Central lesions usually arise from a single milk duct. They are single lesions rarely having a diameter larger than 3 cm. They present as retroareolar masses and cause bloody discharge coming from the nipple. There are no known risk factors for central intraductal papillomas. Peripheral papillomas originate from distant and small canals. They are numerous and small in diameter. Peripheral intraductal papillomas have been associated with a higher risk of breast cancer.

They present with the complaints of mass in the breast and discharge from the nipple. Generally, ultrasonography is the initially performed diagnostic test for the clinical evaluation. Ductoscopy has been introduced in recent years for diagnosis and treatment. The lactiferous duct is visualized with a telescopic camera during ductoscopy.

The standard treatment for peripheral intraductal papillomas is surgery to remove the papilloma and the affected part of the milk duct. Surgical excision typically provides a complete cure and a favorable prognosis in single papillomas.

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