Breast Mass in Pregnancy

Breast Mass in Pregnancy
Karen Y. Oh, MD
DIFFERENTIAL DIAGNOSIS
Common
  • Normal Fibroglandular Tissue
  • Fibroadenoma
  • Simple Cyst
  • Complicated Cyst
Less Common
  • Breast Cancer
  • Lactating Adenoma
  • Abscess
  • Phyllodes Tumor
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
  • Start with breast ultrasound for palpable lumps in pregnancy
  • Differentiate whether cystic or solid
    • Simple vs. complicated cyst (both benign)
      • Complicated cyst could be galactocele
    • Solid mass requires more careful evaluation
      • If benign-appearing, may follow in a young patient, though even benign lesions may grow in pregnancy
      • If suspicious do not hesitate to perform mammogram and ultrasound-guided core biopsy
  • If ultrasound negative, clinical follow-up warranted to assess for any changes
Helpful Clues for Common Diagnoses
  • Normal Fibroglandular Tissue
    • Slightly more echogenic parenchyma
    • Usually very dense on mammographic imaging due to hormonal stimulation of tissue and milk production
  • Fibroadenoma
    • Most common breast mass across all age groups
      • Peak age of occurrence → 20-30 years old
    • Can significantly enlarge during pregnancy
      • Many involute postpartum or after menopause
    • Circumscribed homogeneous mass growing parallel to breast tissues
      • “Wider than tall”
      • Isoechoic or slightly hypoechoic to fat
    • Variable effect on acoustic transmission
      • May have posterior acoustic shadowing, no effect, or increased posterior enhancement
    • If involuted fibroadenoma, may see echogenic, internal coarse “popcorn” calcifications
    • Atypical fibroadenomas may also have irregular or microlobulated margins
      • Should be sampled at any age if appears atypical
  • Simple Cyst
    • Presents as painful palpable mass, often with acute onset
    • Anechoic circumscribed mass
      • Smooth wall without irregularities or solid components
      • Increased through transmission
      • May have thin nonvascular septa
  • Complicated Cyst
    • Low-level internal echoes
      • Proteinaceous debris, cellular debris, or cholesterol crystals
      • Movement often visible with realtime imaging
      • Consider galactocele (cyst filled with milk) if during lactation
    • Can have fluid-debris level
    • Color or power Doppler ultrasound can show active swirling of debris
    • Benign finding; not an indication for removal or biopsy unless patient symptomatic and desires aspiration
      • Aspiration may require 18-gauge needle as fluid can be tenacious
Helpful Clues for Less Common Diagnoses
  • Breast Cancer
    • ˜ 3% of breast cancers occur during pregnancy or lactation
      • Cancers are considered pregnancy-associated if occurs during pregnancy or within 1 year of delivery
    • Palpable hypoechoic, irregular mass; no specific appearance in pregnancy
      • May have posterior acoustic shadowing and echogenic halo
    • Do not hesitate to biopsy if lesion suspicious
      • Breast cancer can occur at any age
    • Late diagnosis common when found during pregnancy
      • Could be due to difficult breast exam, age of patient, rapid growth in setting of many physiologic changes
    • Treatment should be initiated despite pregnancy
      • Including surgery and chemotherapy
      • No significant known risk to the fetus in the 2nd-3rd trimester
      • Radiation therapy usually deferred
    • Most report similar outcome to patients with breast cancer diagnosed outside of pregnancy
      • If compare patients with similar age and stage at diagnosis
      • Some studies suggest prognosis worse during pregnancy if advanced stage at diagnosis
    • If chemotherapy given, can cause premature menopause
  • Lactating Adenoma
    • Not sonographically distinguishable from fibroadenoma
      • Abundant proliferative changes on histology, without atypia
      • Pregnancy-associated changes with secretory activity
    • Occurs during pregnancy and lactation
      • More commonly occurs during pregnancy than lactation
  • Abscess
Aug 10, 2016 | Posted by in OBSTETRICS | Comments Off on Breast Mass in Pregnancy

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