••• Chapter 41^ Breast Disorders^407
❍ What is the purpose of the Montgomery glands?
These glands secrete lubricating substances and IgA that protect the nipple and areola during nursing.
Figure 41.1 A locally advanced phyllodes tumor with ulceration through the skin.
❍ What are the main characteristics of phyllodes tumor?
A circumscribed round to oval nodular mass with a gray-white appearance. They typically present as palpable
masses in the breast. Shiny, stretched, and attenuated skin with varicose veins can overlie a phyllodes tumor as it
pushes against the skin. Skin ulcerations can develop from ischemia secondary to the stretching.
❍ Where do phyllodes tumors metastasize?
Metastasis is uncommon. When it does occur, it can spread to the lungs, and less frequently, liver and bones.
❍ What is the most common benign breast neoplasm?
Fibroadenoma.
❍ What stimulates the growth of a fibroadenoma?
Estrogen.
❍ What are the management recommendations for fibroadenomas?
As transformation into cancer is rare and regression is frequent, current management recommendations are
conservative. Enlarging fibroadenomas or those >2 cm should be excised.
❍ What can happen after menopause in someone with fibroadenomas?
After menopause, fibroadenomas can atrophy from the lack of estrogen causing calcifications in a clustered
arrangement within a round or elliptical mass on mammogram. This appearance can mimic breast carcinoma and
require biopsy.
❍ What is the image modality of the management of a premenopausal patient that presents with a palpable breast
mass?
Ultrasound. Masses may be further evaluated by mammogram, especially if the woman is 30 years of age or greater.