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Benign Breast Lesions Flashcards

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1
Q

What causes a simple cyst in the breast?

A

Obstruction of extralobular terminal duct by fibrosis and intraductal epithelial proliferation, accumulation of secretions causes duct dilatation and cyst forms

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2
Q

Where do simple cysts in the breast arise from?

A

TDLU

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3
Q

What is the MC cause of a breast lump?

A

simple cyst

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4
Q

When are simple cysts in the breast MC?

A

35-50, can persist after menopause with HRT

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5
Q

What does a simple cyst look like on mammogram?

A
  • round/oval
  • water density mass
  • thin halo
  • calcification = eggshell appearance
  • no architectural distortion
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6
Q

What are complicated cysts related to?

A

fibrocystic changes or benign epithelial proliferative disorders

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7
Q

What are possible components of a complicated cyst?

A
  • protein globules
  • cellular debris
  • cholesterol crystals
  • blood
  • purulent material
  • milk of calcium
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8
Q

What are some US features of a complicated cyst?

A
  • thin septations
  • fat-fluid levels
  • fluid-debris levels
  • wall thickening
  • cluster of microcysts
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9
Q

What are differential diagnoses of a complicated cyst?

A
  • complex cyst
  • hemorrhagic cyst or hematoma
  • infected cyst/abscess
  • galactocele
  • sebaceous cyst
  • oil cyst
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10
Q

What is a complex cyst?

A

mixed cyst/solid, related to fibrocystic change or epithelial proliferative disease

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11
Q

What are differential diagnoses of a complex cyst?

A
  • complicated cyst
  • papillary apocrine metaplasia
  • papilloma
  • necrotic tumor
  • colloid carcinoma
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12
Q

What is colloid carcinoma AKA?

A

mucinous carcinoma

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13
Q

What is a sebaceous cyst AKA?

A

epidermal inclusion cyst

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14
Q

How does a sebaceous cyst form?

A
  • from dermal layer of skin
  • obstruction of sebaceous gland or hair follicle
  • also from trauma
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15
Q

What does a sebaceous cyst contain?

A

oil, sebum or keratin

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16
Q

What are the clinical signs of a sebaceous cyst?

A
  • palpable, subcutaneous mass
  • bulge in skin
  • darkened pore
  • inflamed/tender
  • can rupture & cause abscess
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17
Q

Where do sebaceous cysts usually form on the breast?

A

IMF, medial edge, axilla, nipple

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18
Q

What are US features of a sebaceous cyst?

A
  • focal skin thickening
  • low-medium echoes
  • wall calcs
  • possible skin tract
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19
Q

What is a galactocele?

A

milk filled cyst appearing during or shortly after lactation period

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20
Q

What causes a galactocele?

A

obstruction of lactiferous duct or peripheral TDLU

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21
Q

What can happen due to infected galactocele? What can happen to a noninfected galactocele?

A

mastitis or abscess, can also transform into oil cyst (non infected)

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22
Q

Where are galactoceles typically located?

A

retroareolar

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23
Q

What are US features of a galactocele?

A
  • multiloculated
  • fluid-fat levels
  • aspiration: milky fluid
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24
Q

What are mamm features of a galactocele?

A
  • variable density depending on fat content
  • usually radiolucent
  • rim calcs possible
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25
What is the MC diffuse breast disorder?
fibrocystic disease
26
What is fibrocystic disease?
- proliferative and involutional changes - causes variety of stromal and glandular alterations - can occur from exaggerated hormone response
27
What tissue changes can occur due to fibrocystic disease?
- stromal fibrosis - adenosis - epithelial hyperplasia - cysts
28
Who does fibrocystic disease occur in most commonly?
35-55 yo
29
What are clinical signs of fibrocystic disease?
- cyclic breast pain or tenderness - diffuse circumscribed firmness or nodularity - nipple discharge - regress after menopause
30
What differentiates macro vs micro cysts?
macro >2 mm, micro <2 mm
31
What is the US appearance of fibrocystic disease?
- cyst clusters - ductal changes ex. subareolar duct ectasia, thickening - hyperechoic parenchyma - fibrosis: shadowing
32
What is PASH?
pseudo angiomatous stromal hyperplasia, form of fibrocystic disease, precancerous, incidental biopsy finding
33
What does PASH look like on US?
well-defined, irregular hypoechoic mass, discrete region of tissue
34
What are differential diagnoses for PASH?
- fibroadenoma - fibroglandular tissue - spiculated mass
35
What is the MC benign, solid breast mass?
fibroadenoma
36
What is a fibroadenoma made of?
- connective & epithelial tissues - estrogen induced
37
When are fibroadenomas MC?
15-35 (repro age), MC breast tumor under 30
38
What happens to fibroadenomas with age?
- hyalinization - degeneration - sclerosis - necrosis - calcification
39
What happens to fibroadenomas during pregnancy?
rapid growth
40
What are the clinical signs of fibroadenoma?
- discrete, firm, rubbery - non-tender, palpable mass - mobile - <3 cm
41
Who are fibroadenomas more common in?
African American women
42
What are US features of a fibroadenoma?
- solid - well circumscribed - thin, echogenic pseudocapsule - hypo/isoechoic to fat - thin refractive edge shadowing - smaller: homo, larger: hetero
43
What is the appearance of a fibroadenoma on mammo?
- low density, radiopaque - lobulated contour, distinctive notch - thin, radiolucent halo - degeneration = coarse, popcorn or eggshell calcification
44
What is intraductal papilloma?
- focal epithelial proliferation within a duct - usually small, can grow to several cm
45
Where are intraductal papillomas MC?
subareolar within major lactiferous duct
46
What is papillomatosis?
multiple peripheral papillomas, smaller from TDLU, higher risk for malignancy
47
What are clinical signs of intraductal papilloma?
- persistent blood or serous nipple discharge - too small to palpate
48
What ages are intraductal papillomas MC in?
30-55
49
What is the MC cause of bloody nipple discharge?
intraductal papilloma
50
What are US features of a intraductal papilloma?
- sub/periareolar - can be seen with dilated fluid-filled duct - round, oval, tubular - hypo/iso to fat - dilation of single duct may indicate tiny papilloma
51
What imaging technique can be used to document the number and location of intraductal papillomas?
contrast ductography (mamm)
52
What is intracystic papilloma?
papilloma growing from fibrovascular stalk within lumen of serous or hemorrhagic cyst
53
How can a cyst be formed by a papilloma?
Duct is blocked by growing soft tissue tumor
54
What is associated with large intracystic papillomas?
hemorrhagic or malignant change
55
How does an intracystic papilloma appear on US?
- cystic/solid - mural nodule or focal wall thickening - nodule: medium echoes, homo, smooth lobulated contour
56
What is a lipoma?
nodule of mature adipose tissue encased by thin connective tissue capsule
57
Where are lipomas usually found in the breast?
superficial fat layer but can be anywhere, hard to distinguish from fatty tissue
58
What can an axillary lipoma be mistaken for?
lymph nodes
59
What causes calcification of a lipoma?
internal fat necrosis
60
What is a hamartoma?
uncommon intraglandular mass, proliferation of fibrous, glandular and fatty tissues encased by thin layer of connective tissue
61
What is a hamartoma AKA?
fibroadenolipoma, adenofibrolipoma
62
What are clinical signs of a hamartoma?
- asymptomatic - usually >3 cm - soft/firm, movable
63
Where are hamartomas MC?
UOQ, subareolar
64
Who are hamartomas MC in?
early 40s
65
What does hamartoma look like on US?
- thinly encapsulated - oval, lobulated - heterogenous - shadowing dependent on amount of fibrous tissue - moderately compressible
66
What does hamartoma look like on mamm?
- encapsulated island of mixed densities - breast within a breast appearance
67
What are different types of mastitis?
- puerperal - nonpuerperal - infected cyst - inverted nipple with SA abscess - plasma cell - nonspecific - granulomatous - foreign body - certain disease - parasitic
68
What is the US appearance of mastitis?
- skin thickening - increased echogenicity - prominent lymph channels parallel to skin - dilated ducts - edematous parenchyma - hypervascularity - possible abscess formation
69
What is plasma cell mastitis? When does it occur?
nonpuerperal form of mastitis, occurs around menopause
70
What are the clinical signs of plasma cell mastitis?
- nipple discharge - nipple retraction - SA fullness (can mimic cancer) - SA dilated ducts- can lead to periductal inflammation & fibrosis
71
What is acute lactational mastitis?
- bacteria enters breast via cracked nipple or skin wound (usually staphylococcal infection) - carried by blood or lymph, travels through ducts
72
What is the MC cause of acute mastitis? How is it treated?
lactation, resolves with antibiotics
73
What does acute mastitis need to be differentiated from?
inflammatory ca
74
What are clinical symptoms of acute mastitis?
- tender, swelling - plugged duct - purulent discharge - skin thickening, erythema - enlarged painful lymph nodes - leukocytosis & fever
75
Where do breast abscesses MC form and what causes them?
Usually subareolar, complication of mastitis or infected cyst
76
What are predisposing factors for breast abscess?
- puerperal mastitis - infected cyst - inverted nipple - mammary duct fistula - post-op infection - cigarette smoking
77
What is the US appearance of abscess?
- complex fluid collection - anechoic or mixed echo - possibly septated - hypervascular walls
78
What causes a hematoma in the breast?
- vessel damage: trauma, sx, aspiration or biopsy - increased risk if bleeding disorder or on anticoagulants
79
What is a seroma? How is it treated?
- collection of serous fluid following sx - conforms to surgical cavity - small: reabsorbs, large: needs drainage
80
What are the clinical signs of a seroma?
- palp mass at sx site - if in axilla after ALND, can lead to lymphedema
81
What is the sono appearance of a seroma?
- lobulated - anechoic/hypoechoic - complex with septations - enhancement
82
What is fat necrosis and what are its two presentations?
- focal hemorrhage and liquefaction of fat leading to necrosis - fibrotic mass or oil cyst
83
What causes fat necrosis?
inflammatory process or idiopathic
84
Who is fat necrosis MC in?
older women with fatty breasts
85
What does fat necrosis look like on US?
- oil cyst - sclerotic mass - complex, anechoic, fat-fluid level, echogenic bands or mural nodule - increased wall echogenicity
86
What does fat necrosis look like on mamm?
- spiculated mass with possible central lucency - irregular mass without calcs - oil cyst: round, radiolucent mass with or without rim calcs
87
What is a radial scar?
- complex, sclerosing lesion - assoc. with increased risk of cancer in both breasts - diagnosed via biopsy
88
What are the US features of a radial scar?
- spiculated, can mimic cancer - firm, irregular mass - may simulate fat necrosis - ductal hyperplasia
89
What are common side effects of radiation therapy?
skin thickening and fibrosis
90
What are US features associated with radiation treatment?
- skin & parenchymal edema - vascular & lymphatic dilation - fluid collections - fat necrosis - calcs
91
What causes gynecomastia?
increased estrogen and decreased testosterone causes abnormal proliferation of ductal glandular tissue and stroma
92
What are clinical signs of gynecomastia?
- breast enlargement - SA thickening - SA palp mass
93
What are some physiologic causes of gynecomastia development?
- idiopathic - hormonal changes - Klinefelter's syndrome - thyroid disease - testicular failure - neoplasms (testicular, adrenal, hepatocellular) - systemic disease ex. cirrhosis or renal failure
94
What are acquired causes of gynecomastia development?
Drug induced - estrogen treatment - steroids - marijuana - antidepressants - AIDS meds - digitalis therapy

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