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ABDOMEN 4 > 4.2 Breast Pathology > Flashcards

4.2 Breast Pathology Flashcards

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1
Q

Cysts are common findings in age __ - ___

A

35-50 years

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2
Q

Breast cysts are the result of?

A

obstructed ducts

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3
Q

Breast cysts can have these features

A

palpable, rounded, some mobility, single/multiple, variable in size, can change with compression

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4
Q

What are complex cysts in the breast with low level echoes called?

A

Foam cysts

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5
Q

Complex cysts in the breast may also have these features

A

septations, debris and ALWAYS posterior enhancement

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6
Q

Cysts that display a non-dependent echogenic layer?(not mobile debris, solid tissue on cyst wall NOT MOBILE)

A

Acorn cyst

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7
Q

WHAT IS THE MOST BENIGN SOLID TUMOR OF THE BREAST

A

FIBROADENOMAS

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8
Q

Fibroadenomas form in ___ and are stimulated by____

A

adolescence; estrogen

may increase size with prego and HRT

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9
Q

Fibroadenomas appearance?

A

Variable size/shape
uni/bilateral
often appear as palpable, painless and mobile

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10
Q

Fibroadenomas Sonographic appearance?

A 
Eliptical/oval
gently lobulated
Thin echogenic capsule
Hypoechoic
Homogenous
wider than tall
solid
typically no enhancement 
no change with compression (fat lobule will demonstate this)
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11
Q

Rare finding AKA “Giant Fibroadenoma”

A

Cystosarcoma phylloides

larger and more lobulated and can have systic spaces than firadenoma

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12
Q

Are Cystosarcoma phylloides typically benign or malignant?

A

Benign but can be malignant

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13
Q

Cystosarcoma phylloides are common in ages__ to __ and _____ increase in size.

A

40-50; rapidly

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14
Q

A Benign fatty tumor in middle aged/postmenopausal patient, often asymptomatic?

A

Lipoma

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15
Q

Lipoma sonographic appearance

A

May appear as hypoechoic mass (but relative to surrounding tissue)
Defined margins

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16
Q

Hemorrhage or liquefaction of fatty area in breast that leads to necrosis?

A

Fat Necrosis

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17
Q

Fat Necrosis is often a result of ?

A

TRAUMA,(Most common, seatbelt ) surgery or inflammation

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18
Q

Fat Necrosis forms a dense ___ or ___ and the areas may ____

A

Scar or cyst (lipid cysts); calcify

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19
Q

Fat Necrosis can present with (3)

A

Firm nodule, skin retraction, nipple inversion

also seen with malignant nodules, hx important

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20
Q

Sonographic appearance Fat Necrosis?

A

poorly defined, Irregular hypoechoic, complex mass may shadow

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21
Q

Benign solid masses in lining of ducts (can develop into cysts)

A

PAPILLOMA

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22
Q

Papilloma is the most common cause of?

A

bloody nipple discharge

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23
Q

Papilloma typically located?

A

near nipple

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24
Q

Papilloma sonographically

A

Solid lesion in a duct or cyst
possible ductal ectasia (dilation) near mass
Doppler - vascular stalk or feeding artery

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25
A commmon exaggerated cyclic change in breast tissue where cells proliferate and retain water?
FIBROCYSTIC CHANGE
26
Fibrocystic change is typically in this location?
UOQ
27
Fibrocystic S & S
Lumpy, swollen, painful breasts, nodulatity nipple discharge mammographic changes
28
Fibrocystic Sonographically?
multiple cysts, echogenic tissue and small nodules
29
A milky cyst from an obstructed lactiferous duct | seen in prego or lactating
GALACTOCELE
30
Most galactocele are located in the ___ region and can lead to___
retroareolar; mastitis (inflammation of the breast)
31
galactocele Sonographiclly
Well definded cystic mass with internal debris | less posterior enhancement then in simple cyst
32
Dilated Ducts in the breast are called?
DUCT ECTASIA
33
Duct Ectasia appear sonographically as?
tubular hypoechoic structures converging toward the nipple (>8mm)
34
Duct Ectasia are seen in ___ patients or pt >__ years of age. Usually ______ but can lead to ____
lactating ; >50 years; | asymptomatic; mastitis
35
mastitis is the inflammation of the breast. common during lactation. Is more commonly focal or diffuse?
FOCAL
36
Mastitis obstruction can lead to ___ ___ and can form an____
bacterial infection; abscess
37
S+S of mastitis include
``` Hot, red, tender breast, fever, palpable mass (focal form), nipple discharge ```
38
Acute mastitis (inflammation/infection) sonographically?
Irregular fluid collection with debris loss of tissue definition with edema complex, shaggy wall septations, posterior enhancement
39
Nipple discharge that is low risk appears?(benign)
bilateral involving multiple duct orifices milky or greenish fibrocystic change or duct ectasia
40
Nipple discharge that is high risk appears?
unilateral spontaneous (no pressure is needed) clear, bloody or serous (clear yellow fluid) maybe a glactogram procedure ( filling defects )
41
Malignant lesions get characterized by 2 things
Location and invasiveness
42
MOST MALIGNANCY IS LOCATED IN WHAT LOCATION?
UOQ
43
Malignant Characteristics include (LONG LIST)
- Hypoechoic (VERY compared to surrounding) - Taller than Wider - Angled margins/spiculations (spike, lesions have tiny little jagged spikes protruding from them) - Heterogenous - Posterior shadowing - Thick echogenic rim (thicker and more irrgeular than capsule) or halo - Ductal extension/branching - Microlobulations (tiny and more of them) - Calcifications
44
Secondary findings of malignancy include:
- Skin changes (thickening, flattening retraction) - Inverted nipple - Axiallary or intramammary lymph nodes - Dilated ducts - Highly echogenic surrounding tissue - Thickened coopers ligaments
45
What are the 2 types of breast Carcinomas?
Non invasive and Infiltrating (invasive)
46
What are the 3 types of Non invasive?
DCIS (ductal carcinoma in situ) Lobular carcinoma in situ Intracystic papillary carcinoma in situ
47
What are the 3 types of Invasive/infiltrating? | spread outside of duct or lobular they originate in.
Infiltrating ductal Infiltrating lobular Others
48
What does in situ mean?
still in the duct. Not invaded outside of the structure
49
THE MOST COMMON NONINVASIVE MALIGNANT TUMOR | NOT THE MOST COMMON MALIGNANCY
DCIS (ductal carcinoma in situ)
50
DCIS common in postmenopausal and presents with nipple discharge and has what in 80% of the masses?
Microcalcificaitons*
51
Lobular carcinoma in situ has an increased incidence in the ____ years and is not a ____ cancer (more a marker)
reproductive; true
52
Intracystic papillary carcinoma in situ is ___ and more common in middle aged females. It is ___ ___and is a __mass
RARE; well defined; mobile solid.
53
INVASIVE | MOST COMMON TYPE OF BREAST CANCER IS?
Invasive ductal carcinoma | 65%
54
Invasive ductal carcinoma present as? and are located?
Hard stationary, painless, palpable mass ; UOQ
55
Sonographically Invasive ductal carcinoma have(2)
Microcacs and spiculations
56
Less common invasive carcinoma is
Invasive lobular carcinoma. 8-13%
57
THE MOST FREQUENTLY MISSED CANCER?
Invasive lobular carcinoma | difficult to detect on both mammo + US
58
Invasive lobular carcinoma often has development of a second primary in opposite breast and presents with ___ ___
Nipple retraction
59
Other types of invasive carcinoma include?
medullary Mucinous Papillary
60
Medullary are rare ____ growing, ___ aged, looks like fibroadenoma (need biopsy)
fast; middle
61
Mucinous are rare, __ growing in ___ women
slow;older
62
Papillary are in ____women, bloody nipple discharge, central breast area and they have a ____prognosis
postmenopausal; good
63
PRACTICE | Anechoic, oval, distinct backwall, posterior enhancement, single tiny septataion
Complex Cyst with one thin septation
64
Solid mass, homogenous, hypoechoic, oval, well defined, smooth wall, thin echogenic capsule
Fibradenoma
65
Poorly defined, very hypoechoic, few bright echogenic foci (microcalcs), shadowing, thick echogenic rim
Malignant (most common ductal cell carcinoma) also microcalcs. need biopsy to confirm.
66
Augmented Breast can be __ or ___ and be placed anterior or posterior to the ___ ___
silicone or saline; pectoralis muscle
67
What is the concern with breast implants
rupture and | contracture of the capsule, disforming breast and implant
68
Sonographically
echo free oval, posterior to breast tissue (looks like big cysts
69
What is the artifact associated with breast implant?
anterior reverb artifact | most anterior less bright wall is the capsule, body walled it off, other 2 implant shell itself
70
2 features of normal implant to be aware of?
Radial folds | and Fill valves
71
Radial folds are ___ folds that is seen when patient is in ____ position. (normal)
anterior; supine
72
Fill valves seen with ___ implants, typically located directly located ___ to nipple and are ____
Saline, posterior; palpable
73
2 types of silicone leak (rupture)
Intra-capsular | Extra-capsular
74
Intra-capsular tear is?
Tear in shell | gel trapped between capsule (formed by body) and implant shell.
75
Sonographically the Intra-capsular appears as the what sign?
"stepladder sign" | numerous linear echogenic structures in implant
76
Extra-capsular tear is?
Tear through shell and capsule formed by body | silcone leaking into body tissues
77
Sonographically the Extra-capsular appears as the what sign?
"Snowstorm sign" | a lot of echogenic noise
78
Silicone bleeds occur in all silcone implants they are microscopic leaks, through an intact shell that are contained in fibrous capsule. Migrates to the lymph nodes resulting in?
results in lymphadenopathy
79
Contracture of silcone. Normal response is a fibrous capsule forming around implant. The capsule should be _____ than the implant and flexible. With contracture the capsule contracts and _____the breast
larger; Disfigures
80
What is male breast enlargement called?
Gynecomastia
81
What causes Gynecomastia
abnormal proliferation of glandular tissue and increased subcutanous fat.
82
what is Gynecomastia linked to? (3)
Estrogen and androgen use drugs for hypertension and depression estrogenic neoplasms link to breast cancer unclear
83
S & S Gynecomastia
Enlarged breast palpable firm mass under nipple tenderness
84
Sonographically Gynecomastia
Triangular region of hypoechoic glandular tissue under areolar region ducts converging towards nipple can be increased fat

ABDOMEN 4 (10 decks)

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