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Women's Health > Benign Breast Lesions > Flashcards

Benign Breast Lesions Flashcards

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
Q

What is the MC diffuse breast disorder?

A

fibrocystic disease

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26
Q

What is fibrocystic disease?

A
  • proliferative and involutional changes
  • causes variety of stromal and glandular alterations
  • can occur from exaggerated hormone response
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27
Q

What tissue changes can occur due to fibrocystic disease?

A
  • stromal fibrosis
  • adenosis
  • epithelial hyperplasia
  • cysts
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28
Q

Who does fibrocystic disease occur in most commonly?

A

35-55 yo

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29
Q

What are clinical signs of fibrocystic disease?

A
  • cyclic breast pain or tenderness
  • diffuse circumscribed firmness or nodularity
  • nipple discharge
  • regress after menopause
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30
Q

What differentiates macro vs micro cysts?

A

macro >2 mm, micro <2 mm

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31
Q

What is the US appearance of fibrocystic disease?

A
  • cyst clusters
  • ductal changes ex. subareolar duct ectasia, thickening
  • hyperechoic parenchyma
  • fibrosis: shadowing
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32
Q

What is PASH?

A

pseudo angiomatous stromal hyperplasia, form of fibrocystic disease, precancerous, incidental biopsy finding

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33
Q

What does PASH look like on US?

A

well-defined, irregular hypoechoic mass, discrete region of tissue

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34
Q

What are differential diagnoses for PASH?

A
  • fibroadenoma
  • fibroglandular tissue
  • spiculated mass
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35
Q

What is the MC benign, solid breast mass?

A

fibroadenoma

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36
Q

What is a fibroadenoma made of?

A
  • connective & epithelial tissues
  • estrogen induced
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37
Q

When are fibroadenomas MC?

A

15-35 (repro age), MC breast tumor under 30

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38
Q

What happens to fibroadenomas with age?

A
  • hyalinization
  • degeneration
  • sclerosis
  • necrosis
  • calcification
39
Q

What happens to fibroadenomas during pregnancy?

A

rapid growth

40
Q

What are the clinical signs of fibroadenoma?

A
  • discrete, firm, rubbery
  • non-tender, palpable mass
  • mobile
  • <3 cm
41
Q

Who are fibroadenomas more common in?

A

African American women

42
Q

What are US features of a fibroadenoma?

A
  • solid
  • well circumscribed
  • thin, echogenic pseudocapsule
  • hypo/isoechoic to fat
  • thin refractive edge shadowing
  • smaller: homo, larger: hetero
43
Q

What is the appearance of a fibroadenoma on mammo?

A
  • low density, radiopaque
  • lobulated contour, distinctive notch
  • thin, radiolucent halo
  • degeneration = coarse, popcorn or eggshell calcification
44
Q

What is intraductal papilloma?

A
  • focal epithelial proliferation within a duct
  • usually small, can grow to several cm
45
Q

Where are intraductal papillomas MC?

A

subareolar within major lactiferous duct

46
Q

What is papillomatosis?

A

multiple peripheral papillomas, smaller from TDLU, higher risk for malignancy

47
Q

What are clinical signs of intraductal papilloma?

A
  • persistent blood or serous nipple discharge
  • too small to palpate
48
Q

What ages are intraductal papillomas MC in?

A

30-55

49
Q

What is the MC cause of bloody nipple discharge?

A

intraductal papilloma

50
Q

What are US features of a intraductal papilloma?

A
  • 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
Q

What imaging technique can be used to document the number and location of intraductal papillomas?

A

contrast ductography (mamm)

52
Q

What is intracystic papilloma?

A

papilloma growing from fibrovascular stalk within lumen of serous or hemorrhagic cyst

53
Q

How can a cyst be formed by a papilloma?

A

Duct is blocked by growing soft tissue tumor

54
Q

What is associated with large intracystic papillomas?

A

hemorrhagic or malignant change

55
Q

How does an intracystic papilloma appear on US?

A
  • cystic/solid
  • mural nodule or focal wall thickening
  • nodule: medium echoes, homo, smooth lobulated contour
56
Q

What is a lipoma?

A

nodule of mature adipose tissue encased by thin connective tissue capsule

57
Q

Where are lipomas usually found in the breast?

A

superficial fat layer but can be anywhere, hard to distinguish from fatty tissue

58
Q

What can an axillary lipoma be mistaken for?

A

lymph nodes

59
Q

What causes calcification of a lipoma?

A

internal fat necrosis

60
Q

What is a hamartoma?

A

uncommon intraglandular mass, proliferation of fibrous, glandular and fatty tissues encased by thin layer of connective tissue

61
Q

What is a hamartoma AKA?

A

fibroadenolipoma, adenofibrolipoma

62
Q

What are clinical signs of a hamartoma?

A
  • asymptomatic
  • usually >3 cm
  • soft/firm, movable
63
Q

Where are hamartomas MC?

A

UOQ, subareolar

64
Q

Who are hamartomas MC in?

A

early 40s

65
Q

What does hamartoma look like on US?

A
  • thinly encapsulated
  • oval, lobulated
  • heterogenous
  • shadowing dependent on amount of fibrous tissue
  • moderately compressible
66
Q

What does hamartoma look like on mamm?

A
  • encapsulated island of mixed densities
  • breast within a breast appearance
67
Q

What are different types of mastitis?

A
  • puerperal
  • nonpuerperal
  • infected cyst
  • inverted nipple with SA abscess
  • plasma cell
  • nonspecific
  • granulomatous
  • foreign body
  • certain disease
  • parasitic
68
Q

What is the US appearance of mastitis?

A
  • skin thickening
  • increased echogenicity
  • prominent lymph channels parallel to skin
  • dilated ducts
  • edematous parenchyma
  • hypervascularity
  • possible abscess formation
69
Q

What is plasma cell mastitis? When does it occur?

A

nonpuerperal form of mastitis, occurs around menopause

70
Q

What are the clinical signs of plasma cell mastitis?

A
  • nipple discharge
  • nipple retraction
  • SA fullness (can mimic cancer)
  • SA dilated ducts- can lead to periductal inflammation & fibrosis
71
Q

What is acute lactational mastitis?

A
  • bacteria enters breast via cracked nipple or skin wound (usually staphylococcal infection)
  • carried by blood or lymph, travels through ducts
72
Q

What is the MC cause of acute mastitis? How is it treated?

A

lactation, resolves with antibiotics

73
Q

What does acute mastitis need to be differentiated from?

A

inflammatory ca

74
Q

What are clinical symptoms of acute mastitis?

A
  • tender, swelling
  • plugged duct
  • purulent discharge
  • skin thickening, erythema
  • enlarged painful lymph nodes
  • leukocytosis & fever
75
Q

Where do breast abscesses MC form and what causes them?

A

Usually subareolar, complication of mastitis or infected cyst

76
Q

What are predisposing factors for breast abscess?

A
  • puerperal mastitis
  • infected cyst
  • inverted nipple
  • mammary duct fistula
  • post-op infection
  • cigarette smoking
77
Q

What is the US appearance of abscess?

A
  • complex fluid collection
  • anechoic or mixed echo
  • possibly septated
  • hypervascular walls
78
Q

What causes a hematoma in the breast?

A
  • vessel damage: trauma, sx, aspiration or biopsy
  • increased risk if bleeding disorder or on anticoagulants
79
Q

What is a seroma? How is it treated?

A
  • collection of serous fluid following sx
  • conforms to surgical cavity
  • small: reabsorbs, large: needs drainage
80
Q

What are the clinical signs of a seroma?

A
  • palp mass at sx site
  • if in axilla after ALND, can lead to lymphedema
81
Q

What is the sono appearance of a seroma?

A
  • lobulated
  • anechoic/hypoechoic
  • complex with septations
  • enhancement
82
Q

What is fat necrosis and what are its two presentations?

A
  • focal hemorrhage and liquefaction of fat leading to necrosis
  • fibrotic mass or oil cyst
83
Q

What causes fat necrosis?

A

inflammatory process or idiopathic

84
Q

Who is fat necrosis MC in?

A

older women with fatty breasts

85
Q

What does fat necrosis look like on US?

A
  • oil cyst
  • sclerotic mass
  • complex, anechoic, fat-fluid level, echogenic bands or mural nodule
  • increased wall echogenicity
86
Q

What does fat necrosis look like on mamm?

A
  • spiculated mass with possible central lucency
  • irregular mass without calcs
  • oil cyst: round, radiolucent mass with or without rim calcs
87
Q

What is a radial scar?

A
  • complex, sclerosing lesion
  • assoc. with increased risk of cancer in both breasts
  • diagnosed via biopsy
88
Q

What are the US features of a radial scar?

A
  • spiculated, can mimic cancer
  • firm, irregular mass
  • may simulate fat necrosis
  • ductal hyperplasia
89
Q

What are common side effects of radiation therapy?

A

skin thickening and fibrosis

90
Q

What are US features associated with radiation treatment?

A
  • skin & parenchymal edema
  • vascular & lymphatic dilation
  • fluid collections
  • fat necrosis
  • calcs
91
Q

What causes gynecomastia?

A

increased estrogen and decreased testosterone causes abnormal proliferation of ductal glandular tissue and stroma

92
Q

What are clinical signs of gynecomastia?

A
  • breast enlargement
  • SA thickening
  • SA palp mass
93
Q

What are some physiologic causes of gynecomastia development?

A
  • idiopathic
  • hormonal changes
  • Klinefelter’s syndrome
  • thyroid disease
  • testicular failure
  • neoplasms (testicular, adrenal, hepatocellular)
  • systemic disease ex. cirrhosis or renal failure
94
Q

What are acquired causes of gynecomastia development?

A

Drug induced
- estrogen treatment
- steroids
- marijuana
- antidepressants
- AIDS meds
- digitalis therapy

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