Benign breast disease

Perhaps the most remarkable trend relevant to benign breast disease during the past year is the relative paucity of new investigations. This interesting trend is reflected in one of the most remarkable recent texts on this subject. In The Breast: Comprehensive Management of Benign and Malignant Disorders (Bland et al., eds. WB Saunders, 1991), only 70 of 1100 pages are devoted to benign breast disease. The majority of recent reports have focused on three issues: symptomatic treatment of breast pain, expectant management of clinically benign masses in younger women, and cytologic differentiation of benign and precancerous cystic lesions.     

Benign breast disease

This article describes 25 years of clinical experience in the setting of a Breast Health Center devoted to benign and malignant disease of the breast. During this period, more than 100,000 patients have been evaluated and treated for a wide variety of breast problems. This experience has provided an extraordinary opportunity to evaluate the natural history of benign breast disease and the frequent observation that the relevant medical literature does not reflect the entire spectrum of these conditions or the appropriate treatment. Most textbooks on breast disease emphasize breast cancer and the late manifestations of benign breast disease that often require surgical treatment. More than 180,000 cases of breast cancer occur each year in the United States. The number of women with benign breast disease is far greater and can be counted in the millions. For these patients, the well-trained primary care physician can provide appropriate evaluation and treatment, including appropriate recommendations for referral. For most patients with breast symptomatology, the goal is relief of symptoms and resolution of the problem. To accomplish this requires a contemporary knowledgebase combined with adequate time spent with the patient.     

Benign breast disease I: hormonal investigation

One hundred eighty-four patients with benign breast disease (BBD) were studied and compared with 50 normal women. All of the women had ovulatory cycles according to a biphasic basal body temperature and a plasma prolactin in the normal range. Their corpus luteum function was evaluated by way of plasma progesterone (P) and estradiol (E2) determinations at days 5, 7, and 9 of the hyperthermic phase. In the 184 patients, plasma P over plasma E2 ratio during the luteal phase was found significantly lower than in normal women. When the patients were grouped according to type of breast lesions, it appeared that plasma P was constantly lower in all groups than in the normal women, while plasma E2 was either normal or elevated in the groups of patients with adenosis tumors and increased nodularity of both breasts. From these results it may be postulated that an imbalance in the secretion of E2 and P by the corpus luteum is a constant finding in women with benign breast disease.     

Benign and malignant breast pathology.

Research is focused on defining high-risk factors associated with the development of breast cancer and occult metastatic disease in node-negative patients. The interaction between hormones and growth factors is being diligently investigated, both in the genesis of breast cancer and in metastases. The effect of oral contraceptives on breast pathology remains under close scrutiny. Screening mammography for young women is proving to be of doubtful value.     

良性中间型滋养细胞疾病

良性中间型滋养细胞疾病分别由胎盘种植部位中间型滋养细胞形成的过度胎盘部位反应,以及在绒毛膜型中间型滋养细胞形成的胎盘部位结节或斑块。它是一组罕见的妊娠滋养细胞疾病。为了避免临床漏诊或误诊,该文将良性中间型滋养细胞疾病的特点及诊断和预后做一综述。     

Benign disorders of the breast in older women

Five hundred and eighty-one women over the age of 55 years with a benign disorder of the breast have been studied out of a total of 4,379 consecutive consultations for a perceived mammary problem. The relative age specific incidence of benign disorders of the breast dropped dramatically after menopause. Eighty per cent of older patients seen with these phenomena were between 55 and 69 years of age. Older women with benign disorders of the breast were more likely to have had a previous benign finding at biopsy or aspiration than younger patients. The use of hormonal supplements in these women was no different than that believed to occur in the regular population, except in the patients with cysts of the breast. The most common complaint was nodularity with or without pain. Cysts and fibroadenomas were proportionately much less common than in younger women and one-half of the patients who had cysts were taking hormonal supplements. In women more than 55 years of age, papillomas of the duct are responsible for approximately one-third of the nipple discharges, although the most common cause is ectasia of the duct. The postmenopausal involution makes the breast much easier to examine, both clinically and roentgenographically so that diagnosis of benign disorders can be made with reasonable confidence. Cysts can be safely aspirated because cystic carcinomas which do occur in this age group can be fairly easily recognized by gross clinical features.     

Benign lesions of the breast other than fibrocystic change

Benign diseases of the breast other than those labeled as "fibrocystic" in nature can be divided into congenital, developmental, inflammatory, neoplastic, and miscellaneous categories. Several of the most common breast lesions in these categories are discussed in this article.     

Benign schwannoma of the breast: about two cases

Schwannoma is a rare nervous tumor developed on schwan cells. Only 22 cases of breast schwannoma have been published since 2005. It usually appears as a breast lump having clinical and radiological characteristics suggestive of kindness. Its diagnosis is histological. Its treatment is surgical. Through two observations and a review of the literature we would try to remind the characteristics of this tumor.     

Benign breast diseases, contraception and hormone replacement therapy

The term benign breast disease includes a wide and heterogenous spectrum of lesions different for histology and natural history. Approximately 70% of women who undergo a biopsy for benign breast disease have non-proliferative lesions with no increased risk of breast cancer, 26% have typical hyperplasia which is associated with a two-fold increased risk, and only 4% have atypical hyperplasia which is associated with a five-fold increased risk. The data on the effect of steroid hormones on benign breast disease come from observational studies with several potential bias. Most papers have reported that oral contraceptives protect against benign breast disease, whereas some others have suggested that effects of pill are not yet fully clear. As far as hormone replacement therapy (HRT) is concerned, some studies have shown an increased incidence of benign breast disease in long-term HRT users, whereas other investigations have found either no effect or a protective effect. The use of HRT does not appear to influence the clinical pattern of benign breast disease in postmenopausal women, although enlargement of pre-existing cysts or fibroadenomas has been sometimes reported. The limited available data failed to detect a deleterious effect of HRT use in women with benign breast disease, even in those with increased breast cancer risk due to a family history or high-risk benign breast conditions.     

Benign breast diseases: epidemiology, evaluation, and management

Benign breast diseases are common and encompass a spectrum of disorders. The majority of diagnoses will stem from a patient presenting with symptoms such as a mass or discomfort, or as a result of breast imaging which shows abnormalities leading to percutaneous biopsy. When mammographic and pathologic findings are disconcordant or when a high-risk lesion that can be associated with a preinvasive or invasive malignancy is found, formal excisional biopsy is recommended.     

Benign breast disease: studies of prostaglandin E2, steroids, and thermographic effects of inhibitors of prostaglandin biosynthesis

Plasma levels of estradiol (E2), prostaglandin (PG)E2, and progesterone (P) were measured in both phases of the menstrual cycle in 22 women with benign mastopathies and in 5 normal women. In both phases of the cycle, PGE2 blood levels were significantly higher in patients with benign mastopathies than in normal women. In contrast, the plasma levels of both steroids were lower in patients than in controls. An estrogen-directed synthesis of PGE2 is proposed. In 10 patients, breast thermogenic response to inhibitors of PG biosynthesis (aspirin and indomethacin) revealed a cooling effect in 4 cases, a partly positive response in 3 cases, and no response in 3 cases. The 7 cases with positive responses also had a deficiency of variable magnitude of both steroids without an unbalanced P/E2 ratio. In contrast, patients with a negative thermographic response manifested very low levels of progesterone and a low P/E2 ratio. The significance of patients' unresponsiveness to inhibitors of PGE2 biosynthesis is discussed, as well as the implications with regard to breast cancer.     

Gynecologic aspects of breast disease

The principal problem of the gynecologist in the field of breast diseases is the diagnosis of early breast cancer; then he must direct the patient to receive the best and immediate treatment. Obvious carcinoma has a direct approach, but differentiation of lesions which may possibly represent early carcinoma requires judgment and a high degree of suspicion. Haagensen [Diseases of the breast, Saunders, Philadelphia, PA (1971)] has stated that early diagnosis should be followed by cure in 85% of patients. Evaluation of reactions in the breast due to hormones are discussed in this paper. This includes fibrocystic disease, commonly known as chronic cystic mastitis, macrocysts of the breasts, effects of contraceptive and estrogenic hormones, and, finally, hormonal situations in 100 patients with carcinoma of the breast.     

Oral contraceptives and breast disease

Epidemiologic data support the hypothesis that the types of OCs used before the mid-1970s protected against most forms of benign breast disease. It is unclear whether current low-dose progestogen OCs will confer the same protection. Further studies are necessary to clarify this. For breast cancer, the relationship is more complex. It is possible that prolonged use of high-dose OCs exert a small increased risk for breast cancer development in women before age 45. Furthermore, prolonged use before a first term pregnancy may result in a small increase in risk for breast cancer before age 45. Studies evaluating the effect of current low-dose OCs are necessary to elucidate what, if any, effect they may have on breast cancer development. Furthermore, as our population ages, studies will be able to determine what effect, if any, may be present in women over age 60, those women with the highest underlying risk of breast cancer. And finally, more research of basic breast tissue physiology and the effect of endogenous and exogenous hormones on this complex organ is needed.     

Fibrocystic disease of the breast.

Fibrocystic disease is the most common type of lesion in the female breast. It is a common dumping ground for a variety of distinct clinical and histologic entities which require different modalities of therapy and which have different malignant transformation potentials. In general, fibrocystic disease is managed medically unless a dominant lump or other adverse symptom develops, in which case a biopsy is performed. The exception to this rule is a cyst which can be safely aspirated under controlled conditions. If, on biopsy, one of the histologic types of fibrocystic disease called "precancerous mastopathy" is found, which has a high potential for malignant transformation, then serious consideration must be given to definitive surgical procedures, especially if the patient has other risk factors that would increase her risk of developing breast cancer even further.     

Benign granular cell tumor mimicking carcinoma of the breast. Report of a case.

A case of granular cell tumor of the breast in a 59 year-old woman is presented. Clinical evaluation suggested carcinoma with infiltration of the skin. The granular cell tumor was diagnosed on frozen section and the lesion was treated by wide local excision including the overlying skin. Granular cell tumors of the breast, which are usually benign, may closely mimic breast carcinoma, both clinically and on frozen section. The possibility of granular cell tumor of the breast with its potential for a false-positive diagnosis on frozen section supports a two-step procedure for the treatment of breast cancer, especially in young women, to prevent inappropriate radical surgery.