Lecture Notes: Webinar on Benign Breast Pathologies

Introduction

• First webinar of 2024, number 55.
• Focus on benign breast pathologies, rare but benign conditions
• Key speakers: Maggie Banis p Chi (Germany), Michael B (Ireland), Victor akosa Marin (Venezuela), Salim T (UK), na kadogo (UK)

Nipple Adenomas (Victor Akosa Marin, Venezuela)

Overview

• Rare benign condition of the breast
• Mainly affects middle-aged women
• Also known as florid papillomatosis of the nipple

Historical Context

• First detailed by Dr. David Jones (1955)
• WHO's current definition in the 4th and 5th editions

Pathology

• Benign proliferative process of lactiferous ducts
• Three major histopathologic growth patterns: Adenoid, papillary, mixed
• Mainly unilateral, can be bilateral

Clinical Presentation

• Often asymptomatic but can be locally infiltrative
• Symptoms: Swelling, itching, pain, erythema, discharge
• Clinical diagnosis sometimes confused with Paget's disease

Diagnosis

• Core biopsy or excision biopsy required
• Imaging usually negative or non-specific
• Histological examination: Key for accurate diagnosis

Treatment

• Simple excision is curative
• Recurrence is rare
• Importance of complete excision to avoid recurrence

Breast Infections and Abscess Management (Salim T, UK)

Overview

• Focus on mammary fistulas and breast abscesses
• Importance of early and proper management

Mammary Fistulas

• Rare, often secondary to incision and drainage of abscesses
• Risk factors: Smoking, congenital cleft lip

Pathogenesis

• Sequestration metaplasia → keratin plugs → duct blockage → abscesses
• Surgical treatment: Excision of fistula with or without duct excision

Management Techniques

• Fistulotomy, excision with closure, primary closure, oncoplastic techniques
• Success rates vary; minimally invasive approaches are preferable

Breast Abscesses

• Types: Lactational, non-lactational, and skin-associated
• Principles: Aspiration of pus, antibiotics, and patient education

Pathway Implementation

• Importance of ultrasound-guided aspiration
• Decreased need for surgical intervention

Idiopathic Granulomatous Mastitis (Maggie Banis p Chi, Germany)

Overview

• Rare chronic inflammatory condition
• Affects women of childbearing age
• No established risk factors, but hypotheses suggest immune reactions

Clinical Presentation

• Lump, pain, redness, and swelling
• Differential diagnosis includes inflammatory breast cancer

Diagnosis

• Histological confirmation required
• Exclude other granulomatous diseases (e.g., TB, sarcoidosis)

Treatment

• Steroids (local/systemic), immunosuppressive drugs
• Potential for spontaneous remission
• No standardized treatment; case-by-case basis

Upcoming Grammar Study

• Registry study by EU breast study group
• Retrospective and prospective data collection
• Aim: Insights into symptoms, treatment, and recurrence

Desmoid Tumors of the Breast (Michael Boland, Ireland)

Overview

• Very rare benign tumors, locally aggressive but non-metastatic
• Mimic breast cancer clinically and radiologically

Pathology

• Monoclonal fibroblast proliferation
• Immunohistochemistry for diagnosis: Positive for vimentin, beta-catenin, smooth muscle actin

Clinical Presentation

• Common in females, fourth to fifth decade
• History of breast cancer or surgery may be relevant

Imaging

• MRI is the gold standard
• Hypointense on T1, hyperintense on T2

Management

• Historical: Surgical excision, often extensive
• Current: Active surveillance recommended
• Systemic therapies: Tyrosine kinase inhibitors (e.g., pazopanib), hormonal therapy

Guidelines

• Active surveillance with MRI at six-month intervals
• Surgery for aggressive or large tumors

Key Takeaways

• Importance of proper diagnosis and individualized treatment
• Need for further research and data collection for rare pathologies
• Patient education and involvement in treatment decision-making are crucial