benign breast diseases summary. i hope it's helpful.

1. Mays Yousuf Ismail© BenignBreastdiseases Al-Qudsuniversity;Palestine
 Breast is a modified sweat gland. It's development starts at gestational week 6.
 Pubertymarksthe beginningof the glandularmaturation,butfull breast differentiation
occurs only in pregnancy and lactation.
 At birth: 10-12 primitive ducts are around the nipple
 Pre-puberty: Each duct branches and canalizes
 Pubertytoadult:more branching,canalization,anddifferentationof terminal ductunit.
 Terminal ductunitmaturation:alveolarbuds formation thatfinallydifferntiate to acini.
 Each 11 acini collect around a terminal duct to make Lob 1.
 Lob 1: pre-puberty
 Lob 2: puberty
 Lob 3: pregnancy and lactation.
 Arterial supply:
1. Internal thoracic artery: anterior perforating arteries
2. Axillary artery: lateral thoracic and thoracoacromial arteries.
3. Intercostal arteries.
4. The venous supply corresponds to the arteries.
5. The intercostal veins: mets to the brain through comunication via space baston.
 Lymphatics:
1. Level 1: lateral and lower:anteriorandposteriorandlateral to the pectoralisminor
2. Level 2: behind: central
3. Level 3: medial and above: apical "halsted"
Lymphatics cross the diaphragm but not the midline, in contrast to the veins.
 Benigndiseases of the breast: occur in the 2nd
decade, and peak in the 4th
-5th
decades.
 Inflammatory
Duct ectasia:
Subareolar non-cyclical pain with bilateral multiple nipple discharge.
Nipple retraction/subareolar mass/Hx of abscess or fistula/eczema.
Tx: total duct excision.
Fat necrosis:
May follow any inflammatory/proliferative/traumatic breast disease.
 Fibrocystic disease: found in almost every woman. (90% of women).
All types carry a variable risk of cancer. Hormonal

2.  Divided into:
1. Proliferative with atypia:atypical ductal and lobular hyperplsia
2. Proliferative withoutatypia:radial/sclerosng/papiloma/ducthyperplsia
3. Nonproliferative:cyst/apocrine metaplasia/fibroadenoma/calcification
/mild ductal hyperplasias
Sclerosing adenosis:
Beningn disease of the perimenopausal women. Ductal proliferation with stromal
fibrosis. It has multiple calcified microcysts. It's totally benign.
Radial scar:
Central sclerosiscircledbyapocrine metaplasiaandpapillomasatthe terminal ducts
Apocrine metaplasia:
Columnar cells with eosinophilic cytoplasm and granules resemble sweat glands.
Ductal papilloma and papillomatosis:
Minimum of 5 intraductal hyperplasia. Benign mostly.
Diabetic mastopathy:
Lymphocytic infiltration in DMtype 1. Painless immobile mass. Do US then biopsy.
PASH:
Benign stromal proliferation in pre (post) menopausal women on HRT.
 Fibroadenoma:
1. An abberation of normal development occurs in women 20-30s.
2. No riskof cancer unlesscomplex (cystic/calcifications/papilloma…) <0.3%
3. Enlarge in pregnancy; hormonal
4. No cancer risk
5. Regress alone in 7 years.
6. Usually patient < 30 years
 Phyllodes tumor: cystosarcoma
1. Unilateral single mass mainly ROQ increases in size.
2. Cancer potential.
3. Removal with safety margin 2-5 cm is enough.
4. Usually patient > 30 years
5. Don't look for LNs. First mets to the lung.
 Another name for hamartoma is adenolipoma.
 Nipple adenoma: nipple mass in pregnant or lactating women. Might erode and
bleed. Simple excision.