Intraductal papillomas
Papillomas (Papillomas) are lesions located inside the ducts of the mammary gland. Clinically, they often manifest as bloody nipple discharge.
On mammography, papillomas appear as well-circumscribed nodes, predominantly in the retroareolar region. They can be multiple and sometimes contain microcalcifications. Ultrasound examination reveals them as a filling defect within a dilated duct or cyst (which may contain blood). Color Doppler flow imaging helps differentiate the papilloma tissue itself from debris accumulation.
The main danger of papillomas is the risk of cellular atypia, which increases the probability of malignant transformation, especially with multiple lesions in the peripheral breast tissue. Since radiological methods cannot distinguish benign papilloma from papillary carcinoma, percutaneous biopsy is mandatory. If atypia is detected or discharge is present, surgical excision is indicated. In the absence of atypia, vacuum-assisted breast biopsy (VAB) is an option.
Fibroadenoma and phyllodes tumor
Fibroadenoma (Fibroadenoma) is a frequently occurring lesion. On mammography, it is visualized as a well-circumscribed node (sometimes multiple nodes). On ultrasound, fibroadenoma appears as a clearly demarcated oval-shaped mass. Ultrasound-guided core needle biopsy is performed to confirm the diagnosis.
Phyllodes tumor (Phyllodes Tumour) is a larger lesion. On sonography, it appears as a large, well-circumscribed lesion with multiple internal cystic spaces. Diagnosis requires core needle biopsy followed by surgical removal.
Lipoma and hamartoma
Lipoma (Lipoma) consists of adipose tissue. On palpation, it is a soft, lobular mass.
- Mammography: large lipomas appear as radiolucent nodes enclosed in a thin capsule.
- Ultrasound: a well-circumscribed mass, hyperechoic relative to the surrounding adipose tissue.
Hamartoma (Hamartoma) is a benign lesion containing normal components of the mammary gland: lobules, stroma, and fat. It occurs at any age. Visually, a hamartoma can mimic a fibroadenoma or may not be palpable at all. On mammograms, it is a large, demarcated mass containing a mixture of dense and radiolucent areas. The difficulty lies in the fact that during a biopsy, the pathologist may describe the material simply as "normal breast tissue".
Briefly: answers to topical questions
What morphological verification (biopsy) methods are used to diagnose benign breast lesions?
For the morphological verification of breast lesions, percutaneous biopsy—including ultrasound-guided core needle biopsy—and vacuum-assisted breast biopsy are used. Core needle biopsy is performed with a 14G needle, while vacuum-assisted breast biopsy uses 7–11G needles; the biopsy is performed under imaging guidance.
What are the histological differences between a phyllodes tumor and a fibroadenoma?
Histologically, fibroadenoma is represented by ducts and fibrous stroma with intracanalicular or pericanalicular architectural patterns. A phyllodes tumor is characterized by cystic spaces lined with epithelial and myoepithelial cells, while the stroma grows in an intracanalicular pattern, forming typical leaf-like (foliaceous) structures.
Which benign breast lesions are most commonly accompanied by calcifications on mammography?
Sources describe calcifications in fibroadenoma and fat necrosis. Fibroadenoma is characterized by large, coarse popcorn-like calcifications, while fat necrosis features eggshell-like ring calcifications at the periphery of the lesion with a radiolucent center.
Class and exam questions
Why is a papilloma biopsy mandatory?
Based on radiological signs (ultrasound or mammography), it is impossible to reliably distinguish a benign intraductal papilloma from papillary carcinoma. Therefore, morphological verification using percutaneous biopsy is required.
What does a lipoma look like on ultrasound?
Unlike many other nodes, a lipoma has a characteristic hyperechoic appearance compared to the surrounding normal adipose tissue and clear margins.
What is a breast hamartoma?
This is a benign tumor consisting of a mixture of normal tissues: lobular structures, stroma, and fat. For this reason, it is difficult to diagnose histologically, as the cells look like normal breast tissue.
What else to study on this topic
- Mechanisms of microcalcification formation
- Vacuum-assisted breast biopsy (VAB): technique and indications
- Radiological diagnostics of carcinoma in situ
- Specific and non-specific types of invasive cancer
- Immunophenotypes of breast cancer (luminal, HER-2+, triple-negative)
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