Welcome to the second episode of the two part series of my conversation with Dr Peter Davis. Here we talk about all things related to benign breast conditions.
Dr Peter Davis is a histopathologist who analyses breast specimens that we take, either as a biopsy or a surgical specimen. Together with his team, they examine the tissue under the microscope and come up with a diagnosis.
In this episode, we continued where we left off from the first episode. We talked about a few more common benign breast conditions that we encounter. They included fibrosis, ADH (atypical ductal hyperplasia), radial scar and microcalcification.
If you missed the previous episode, you can listen to it here.
To summarise, these were the conditions we talked about:
1. Sclerosing adenosis
This is where there is proliferation of the glands of the breast with a degree of fibrous tissue. It can have a distorted appearance sometimes and be mistaken as an early cancer but is completely benign. Using immuno-histochemistry to confirm these features can be very helpful.
This is firm tissue that holds the breast architecture. Occasionally, fibrosis can be seen more prominently in places. It can be a consequence of surgery, fat necrosis, a reaction to previous injury or can be present without a known cause. It looks contracted and may look concerning and hence a biopsy is usually performed.
3. ADH (atypical ductal hyperplasia)
This is a proliferation of the epithelial lining of the ducts. It can be associated with ductal carcinoma in situ. It is considered to share some genetic abnormalities with low grade non-invasive cancers. The presence of ADH usually prompts us to remove slightly more tissue to ensure that there is no cancer situated within the area.
4. Radial scar
These are areas where there is fibrosis that pulls the breast ducts inwards. The stroma can also look contracted. A radial scar can look worrying on both imaging and underneath the microscope. However, again with the help of immunohistochemistry, if a radial scar is confirmed, then it is a benign condition. Radial scars are also known as complex sclerosing lesion.
5. PASH (pseudoangiomatous stromal hyperplasia)
This is a kind of fibrosis that looks like blood vessels. Unlike the normal diffuse nature of fibrosis, PASH is more demarcated hence its propensity to form masses.
This is not a haematoma which is a blood collection. Hamartomas are benign proliferations where all the elements of the breast grow in a disorganised fashion. Clinically and radiologically, hamartomas can present as lumps. However, on biopsy, normal breast tissue is obtained. Only when imaging is reviewed, we can make the correlation between a normal breast tissue result and it coming from a hamartoma.
7. Microcalcification (MCC)
This is where calcium (chalk) appears as tiny droplets, often where secretions in the breast solidifies and turn into calcium. These can then appear as fine flecks on a mammogram. Occasionally MCC can be found as a consequence of columnar cell change where the cells grow slightly taller. However, benign MCC can be seen often with no identifiable cause.
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