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Paeds & Superficial (MIDS 227) > Breast Pathology (Module 2 Unit 4A) > Flashcards

Breast Pathology (Module 2 Unit 4A) Flashcards

1
Q

What are the most common cause of breast lumps in women 35-50 years of age?

A

Cysts

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2
Q

What is commonly found in the fibrocystic change (FCC)?

A

Cysts

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3
Q

What is the most common benign diffuse breast condition?

A

Fibrocystic Change

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4
Q

What are the 4 key features of FCC?

A

Hyperplasia, adenosis, stromal fibrosis, and cyst formation

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5
Q

In FCC, describe the appearance of nodular adenosis and sclerosing adenosis.

A

nodular adenosis - mass like
sclerosing adenosis - difficult to differentiate from cancer (presense of calcs, lobulation, irregular)

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6
Q

Describe an acorn cyst.

A

Non dependent echogenic layer, shows movement of fat layer to differentiate from other pathologies)

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7
Q

What is PAM?

A

Abnormal change/growth of cells, associated with fibrocystic change, echogenic echoes (crescent layer, NON-MOBILE)

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8
Q

What is the most common benign mass in lactating patients?

A

Galactocele

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9
Q

What type of cyst can a Galactocele become?

A

Lipid (oil) cyst

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10
Q

If you move a patient around who has a galactocele, what will it look like sonographically?

A

Fluid-fat levels with change with pt position, internal echoes (milk-laden contents) or completely anechoic

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11
Q

What are sebaceous cysts and epidermal inclusion cysts?

A

Benign masses from skill layers, results from obstructed sebaceous (oil-producing) glands or hair follicles, in a superficial location

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12
Q

What type of cyst contains sebum or keratin?

A

Sebaceous cyst/epidermal inclusion cyst

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13
Q

What type of cyst contains sebum, is superficial, and shows as a darkening of the pore of the obstructed gland?

A

Sebaceous cyst

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14
Q

What is mastitis? When is it common?

A

Inflammation of the breast and is most common during pregnancy and lactation

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15
Q

A patient comes in with a swollen breast, painful to the touch boob, nipple discharge, and their breast is hard – what might be the diagnosis?

A

Mastitis

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16
Q

What is the most common place for a breast abscess?

A

Subareolar

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17
Q

What is Mondor disease?

A

Acute thrombophlebitis of the superficial veins of the breast or chest wall.

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18
Q

What are the sonographic appearances of Mondor disease?

A
  • Dilated tubular vein with internal echoes from clot
  • Incomplete compressibility
  • Absent blood flow or partial absence of flow
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19
Q

How can hematomas happen in the breast?

A

Result of trauma/injury and subsequent vessel damage

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20
Q

What is a seroma?

A

Collection of serous fluid

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21
Q

What is the sonographic appearance of a seroma?

A
  • fluid collection (anechoic or low level echoes/septations)
  • obvious posterior enhancement
  • typically confirms to surgical cavity
  • absence of internal vascularity on doppler
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22
Q

What is fat necrosis?

A

Inflammatory, ischemic process due to the breast trauma (injury, radiotherapy, surgery, inflammation)

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23
Q

What are the risk factors for fat necrosis?

A

Obesity (large fatty breasts) , surgical excisions follow by radiation, diabetes (spontaneous fat necrosis)

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24
Q

Why is the clinical history important for fat necrosis?

A

Signs and symptoms mimic cancer - palpable area, skin thickening, dimpling, nipple retraction

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25
Q

What is sonographic appearance of fat necrosis?

A

Variable; can evolve to a solid, suspicious appearing lesion due to fibrosis and granuloma formation (fibrotic fat necrosis - spiculated/irregular, hypoechoic shadowing mass)

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26
Q

What are the sonographic findings for a post surgical scar?

A
  • hypoechoic area with acoustic shadowing
  • skin thickening or retraction is common
  • transducer pressure can flatten out the scar and reduce shadowing
  • diminish with time on serial scans
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27
Q

What are benign characteristics for a breast mass? (4)

A
  • hyperechogenicity
  • wider than tall
  • multilobulated
  • thin, echogenic capsule
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28
Q

What are the malignant characteristics for a breast mass? (7)

A
  • spiculation
  • taller than wide
  • angular margins
  • markedly hypoechoic
  • shadowing
  • calcifications
  • duct extensions
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29
Q

What is the best modality to examine nipple discharge?

A

Galactography

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30
Q

What is considered ‘low risk’ for nipple discharge? (3)

A
  • bilateral
  • multiple duct orifices
  • milky/greenish
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31
Q

What is considered an ‘increased risk’ for nipple discharge? (5)

A
  • unilateral
  • spontaneous
  • single duct orifice
  • clear, serous, or slight to frank blood
  • associated with skin or nipple changes
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32
Q

Name 6 benign solid breast masses.

A
  • fibroadenoma
  • adenoma/secretory adenoma
  • phyllodes tumour
  • hamartoma
  • lipoma
  • intraductal papilloma/intracystic papilloma, and pappilomatosis
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33
Q

What is the most common benign SOLID tumour?

A

Fibroadenoma

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34
Q

What is an estrogen-induced tumour that is slow-growing, and more commonly solitary?

A

Fibroadenoma

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35
Q

What is the sonographic appearance of a fibroadenoma?

A
  • oval (wider than tall)
  • thin echogenic capsule
  • isoechoic or hypo compared to fat
  • solid
  • may calcify over time and show macrocalcs
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36
Q

What is more common: adenomas or fibroadenomas?

A

Fibroadenomas

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37
Q

What type of adenomas are present during pregnancy or the lactation period due to elevated hormones?

A

Secretory adenomas

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38
Q

What is the sonographic appearance of an adenoma?

A
  • oval, circumscribed, parallel-orientated (wider than tall)
  • internal areas of increased echogenicity
  • increased vascularity on doppler
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39
Q

What is a rare fibroepithelial tumour that is leaf-shaped?

A

Phyllodes tumour (Phylloides)

40
Q

What is the average age to develop Phylloides?

A

Around late 40s

41
Q

What leaf-shaped tumour has a malignant potential if not removed?

A

Phyllodes tumour

42
Q

What is the sonographic appearance of Phyllodes Tumour?

A
  • cystic spaces
  • wider than tall
  • thin echogenic capsule
  • isoechoic or hypo compared to fat
  • solid
  • calcs are not typical
43
Q

What is a hamartoma?

A

A benign tumor like malformation, a pseudotumor

44
Q

What are the signs and symptoms of a hamartoma?

A

Unilateral and measure over 3cm when diagnosed, painless, soft/rubbery

45
Q

What are the 3 types of benign papillary lesions?

A
  • Intraductal (large duct) papilloma
  • Peripheral papillomatosis
  • Juvenile papillomatosis
46
Q

What is the most common benign papillary lesion?

A

Intraductal papilloma

47
Q

Where does intraductal papilloma develop?

A

Centrally behind/close to the areola, within a major lactiferous duct

48
Q

What are the signs and symptoms of intraductal papilloma?

A
  • bloody or watery discharge (#1 cause of spontaneous bloody nipple discharge from a single breast duct)
  • asymptomatic
49
Q

Should an intraductal papilloma be removed, or left alone?

A

Removed, due to the increase risk of breast cancer

50
Q

What is the sonographic appearance of an intraductal papilloma?

A
  • dilation of the duct
  • soft tissue mass
  • vascularity in the stalk
  • radial scanning allows better visualization
51
Q

Where is the most common location for malignant breast masses to develop?

A

UOQ

52
Q

What are the contributing factors to a breast malignancy?

A
  • increased age
  • female
  • personal or fam history of breast ca
53
Q

What genetics significantly increase the risk of developing breast cancer?

A

BRCA1 and BRCA2

54
Q

What are the grades of cancer cells and which is worst?

A

Grades 1-3, 3 being the worst

55
Q

What is non-invasive cancer termed?

A

Carcinoma in situ - confined within the space

56
Q

What are two types of carcinoma in situ?

A

Lobular Carcinoma In Situ (LCIS)
Ductal Carcinoma In Situ (DCIS)

57
Q

What in situ cancer isn’t considered a malignancy and is not treated clinically as a true cancer but is instead a significant increased future risk of developing cancer?

A

LCIS

58
Q

What is the most common noninvasive breast cancer?

A

DCIS

59
Q

Ductal Caricnoma In Situ (DCIS) is best detected using which modality?

A

Mammography

60
Q

What is the mammo and US appearance for DCIS?

A

Mammo - microcalcs in a ground or following a linear/branching pattern

Sonography - microcalcs, distended duct, hypoechoic mass

61
Q

What is Paget disease?

A

Cancer of the epidermis of the nipple

62
Q

What cancer initiates Paget disease?

A

DCIS

63
Q

What are the signs and symptoms of Paget disease?

A
  • eczema-like crusting of the nipple areola, redness or ulceration
  • nipple discharge and itching
64
Q

What is the most common breast cancer of all time?

A

Invasive Ductal Carcinoma (IDC)

65
Q

What appears in the advanced stages of IDC (invasive ductal carcinoma?

A

Skin dimpling, nipple retraction, or breast contour changes

66
Q

What does IDC look like on mammo?

A

Asymmetric, irregular, radiodense mass with spiculated margins; clustered microcalcs are common; thick/straight coopers ligaments

67
Q

What is the sonographic appearance of IDC?

A
  • irregular shaped
  • hypoechoic (MARKEDLY hypoechoic)
  • spiculated margins
  • clustered microcalcs
  • shadowing
68
Q

What is the 2nd most common invasive breast malignancy?

A

Invasive Lobular Carcinoma (ILC)

69
Q

What type of growth pattern does ILC have?

A

Diffuse

70
Q

What are the s/s of ILC?

A
  • hard, fixed, mass
  • may feel like an area of nonspecific thickening
  • tissues can retract, “shrinking breast” and nipple retraction
71
Q

Calcs are not common in which malignancy?

A

ILC (invasive lobular carcinoma)

72
Q

What type of carcinoma is rare, well marginated, occurs in young women, central necrosis is common, grows rapidly, and is located UOQ?

A

Medullary carcinoma

73
Q

What is a mucinous carcinoma that is rare, more common in elderly` women, and is slow growing?

A

Colloid carcinoma

74
Q

What carcinoma may mimic a fat lobule or lipoma, but is less compressible?

A

Colloid carcinoma

75
Q

What type of carcinoma is more common in men?

A

Papillary carcinoma

76
Q

What type of carcinoma has a high incidence in men and also has bloody nipple discharge?

A

Papillary carcinoma

77
Q

Which type of carcinoma is small, slow growing, rare, prominent reactive fibrosis, and has a good prognosis?

A

Tubular carcinoma

78
Q

What is inflammatory carcinoma?

A

Occurs when highly invasive cancer infiltrates the lymphatics of the skin, abrupt onset, rapid progression (aggressive), poor long term prognosis

79
Q

What are the signs and symptoms of inflammatory carcinoma?

A
  • red, warm, and edematous skin
  • orange peel appearance
  • painful and hard breast
80
Q

What is a differential diagnosis for inflammatory carcinoma?

A

Abscess, mastitis

81
Q

What is the sonographic appearance of inflammatory carcinoma?

A
  • hypoechoic shadowing mass
  • thick, echogenic skin
  • dilated lymph vessels and veins
  • hypervascularity of surrounding tissue
  • edema
82
Q

What is the first site of mets spread from a primary breast cancer?

A

The ipsilateral axillary lymph nodes (same side axillary nodes)

83
Q

What lymph node is at most risk for mets?

A

Sentinel node

84
Q

What are the most frequent sites for primary breast cancer to metastasize to?

A

bone, liver, lung, brain

85
Q

Where do mets FROM breast go? (4; 3 nodes, 1 ect)

A
  • axillary LN (most common)
  • internal mammary nodes
  • supraclavicular nodes
  • distant sites (bone, liver, lung, brain)
86
Q

Where do mets TO breast come from?

A
  • M/C from contralateral breast
  • 2nd M/C from melanoma
87
Q

What are the most indicative features of benign lymph nodes associated with the breast? (6)

A
  • oval, kidney shape
  • circumscribed smooth margins
  • symmetric hypoechoic outer cortex
  • hyperechoic fatty hilum
  • hilar doppler flow
  • intramammary nodes less than or equal to 1cm
88
Q

What are the most indicative features of malignant or worrisome lymph nodes associated with the breast? (6)

A
  • rounded, irregular shape
  • enlarged diameter
  • eccentric cortical thickening
  • displaced, indented or absent echogenic fatty hilum
  • markedly hypoechoic cortex
  • heterogenous cortex
  • indistinct cortical wall
  • transcapsular blood flow
  • side asymmetry
89
Q

What is the most common breast abnormality in men?

A

Gynecomastia

90
Q

An increased estrogen-testosterone ratio may be associated with what in men?

A

Gynecomastia

91
Q

What is pseudogynecomastia?

A

Male breast enlargement caused by excessive fat deposition without subareolar ductal proliferation

92
Q

What are the signs and symptoms of gynecomastia?

A
  • soft to mildly firm
  • mildly tender
  • area of firmness
  • nodularity beneath the areola
93
Q

Male breast cancer has a strong association to which syndrome?

A

Klinefelter syndrome

94
Q

Where is primary male breast cancer typically located?

A

Beneath the areola

95
Q

What is the most common primary tumour for men?

A

IDC

Paeds & Superficial (MIDS 227) (12 decks)

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