Benign Pathology Findings

(pathology findings explained)

A fibroadenoma is a solid, benign tumor. Fibroadenomas are a common cause of a mass in teenagers and young women. The majority of fibroadenomas can be observed and do not need to be removed or excised. We consider removing them when they are large or if they are clearly growing. Most fibroadenomas will be tender to the touch meaning that they will hurt if they are directly pressed on. However, for most women, once they are reassured that this discomfort is not worrisome, find the pain a mild nuisance and they opt to not have a surgery to remove the lump. Thus, the majority of these lesions can just be observed. A plan for how to observe and follow a known fibroadenoma would be a part of your office visit. Some women form multiple fibroadenomas. These women require thoughtful management. They usually benefit from a surgeon directed whole breast ultrasound that is combined with a physical exam that maps out the size and location of all of her lesions. The judicious use of core biopsy for diagnosis and when an excision of a lesion becomes necessary, careful surgical planning with attention to incision location can be important. The field of genetics continues to advance our understanding of breast issues. A mutation in the MED12 gene does seem to be associated with the formation of fibroadenomas and uterine fibroids.

Intraductal Papillomas are small benign growths that occur in the milk duct of the breast. They frequently come to our attention as they are a common cause of nipple discharge. They can present as a palpable lump or as a lesion on imaging. gThese were typically removed in the past but now it is becoming clear that the majority of intraductal papillomas can be left in place and will cause the patient no harm. With this knowledge, it is now much more common to observe these benign lesions. We currently do not have well established guidelines on which papillomas can be observed and which ones need to be removed. This is a situation where a careful evaluation by a breast surgeon and shared decision making is appropriate.

Sclerosing Adenosis is a benign condition that seems to originate from an entity that we call the terminal duct lobular units. (Terminal duct lobular units are a combination of the lobule or sac that makes the milk and the first portion of the milk duct that attaches to that sac.) It usually causes multiple small firm nodules that can group together to form a poorly defined mass. The lump can be tender or painful. The lump might be found on exam of the breast or it might show up on am imaging study. The diagnosis may be suspected by the imaging but cannot be confirmed without a needle core biopsy. Ultrasound guided core biopsied can be performed in the office, often at your first visit, if time allows. Sclerosing adenosis can also present as microcalcifications. In this situation, a stereotactic core biopsy may be indicated. These are done on special equipment in the radiology suite. Sclerosing adenosis does not need to be excised, observation is standard.

There are a set of breast lesions that can be found on core biopsy that in some circumstances can be observed and in other situations, need to be excised. These lesions include radial scar, complex sclerosing lesion, and PASH (pseudo angiomatous stromal hyperplasia). Firm guidelines have yet to be established so when these lesions are found on a core biopsy, one usually needs to consult with a breast surgeon who evaluates the imaging, the pathology and the breast exam and then makes a recommendation.