rady 413 case presentationmsrads.web.unc.edu/files/2018/04/breastverma3.pdf · to the development...
TRANSCRIPT
![Page 1: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/1.jpg)
RADY 413 Case Presentation
![Page 2: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/2.jpg)
30-year-old female at 7 months gestation presenting with new
right breast mass
![Page 3: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/3.jpg)
Ms. CC is a 30-year-old female at 7 months gestation presenting with a new right breast mass. She first noticed the mass two weeks ago. She denies pain, redness, breast swelling or nipple discharge. She has no family history of breast cancer.
Physical examination demonstrates an oblong mobile palpable mass.
![Page 4: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/4.jpg)
* Targeted ultrasound of the right breast
![Page 5: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/5.jpg)
Demonstrated a 3.2 x 1.8 x 4.1 cm partially
circumscribed, oval/macrolobulated,
heterogeneously hypoechoic mass.
BIRADS 4A: Suspicious. Low suspicion for malignancy. Biopsy should be performed in the absence of clinical contraindication.
![Page 6: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/6.jpg)
Using ultrasound guidance, aseptic technique, and 1%
lidocaine as the local anesthetic, the mass of concern was sampled 3 times with a 14-gauge Achieve biopsy needle.
![Page 7: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/7.jpg)
* Lactational hyperplasia* No atypia and no in situ or invasive carcinoma
identified
* Patient reassured regarding benign etiology and clinical follow-up recommended
![Page 8: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/8.jpg)
* Alterations in circulating serum estrogen, progesterone, and prolactin levels during pregnancy and lactation lead to increased breast size, firmness, and nodularity
* These hormonal alterations also result in changes in the histologic appearance of normal breast parenchyma, causing progressive enlargement of the lobules with increasing luminal distension
* “Lactational hyperplasia” refers to these normal physiologic changes
![Page 9: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/9.jpg)
* Hormonal changes during pregnancy can also lead to the development of a lactating adenoma
* Benign stromal tumor
* Seen primarily during the third trimester of pregnancy and lactation, but may also be observed during the first and second trimesters
* Typically present similarly to fibroadenomas: painless, soft, mobile, masses
* May also infarct and present as firm, tender mass
![Page 10: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/10.jpg)
* Appears on ultrasound as a hypoechoic, parallel, oval or lobulated mass
* Mimics a fibroadenoma* May be multiple and bilateral* Often displays posterior acoustic enhancement due to high
amount of secretions* Tend to regress following cessation of breastfeeding
Example of a lactating adenoma in a patient at 8 months gestation presenting
with a newly palpable mass. Well-circumscribed, oval mass containing one
calcification.
* Lactating adenoma
![Page 11: RADY 413 Case Presentationmsrads.web.unc.edu/files/2018/04/BreastVerma3.pdf · to the development of a lactating adenoma * Benign stromal tumor * Seen primarily during the third trimester](https://reader034.vdocument.in/reader034/viewer/2022051914/60056d6fd54e1c4229237c71/html5/thumbnails/11.jpg)
Lee, Sheila S., et al. “The Management of Breast Symptoms in the Pregnant and Lactating Patient.” Current Obstetrics and Gynecology Reports, vol. 2, no. 1, 2013, pp. 53–58., doi:10.1007/s13669-012-0037-0.
Vashi, Reena, et al. “Breast Imaging of the Pregnant and Lactating Patient: Physiologic Changes and Common Benign Entities.” American Journal of Roentgenology, vol. 200, no. 2, 2013, pp. 329–336., doi:10.2214/ajr.12.9845.