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Breast Sonography > Benign Disease > Flashcards

Benign Disease Flashcards

1
Q

Age range - simple cysts

A

35-50

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2
Q

Simple cysts may ___ after menopause (except in those using ___).

A

regress, HRT

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3
Q

🎗 Simple cysts tend to result from the obstructed ducts at level of ___.

A

TDLU

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4
Q

What causes the obstructed ducts that lead to simple cysts?

A

fibrosis or proliferative changes in the duct epithelium, sometimes hormonal changes

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5
Q
  1. single or multiple
  2. unilateral or bilateral
  3. variable size
  4. palpable or non-palpable
  5. silent or painful
  6. moveable
  7. compressible
A

7 aspects of cysts:

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6
Q

On mammo, simple cysts appear… (4)

A
  1. rounded
  2. smooth margins
  3. radiopaque (water density)
  4. halo sign (lucent rim of fat)
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7
Q

On sonography, what three criteria are required for a cyst to be classified as simple?

A
  1. anechoic
  2. well-circumscribed
  3. acoustic enhancement
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8
Q

What % of breast cysts are simple?

A

11%

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9
Q

Next steps when sonography finds a simple cyst?

A

none, unless it’s so big/painful that it needs aspiration

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10
Q
  1. improper TGC
  2. overall gain too high
  3. focus wrong
  4. too superficial
  5. too deep
  6. small cyst size
  7. side lobe artifact
  8. slice thickness artifact
  9. volume averaging artifact
A

What technical issues can cause artifact in a simple cyst?

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11
Q
  1. complicated
  2. complex
  3. clustered micro
  4. septated
  5. calcified
A

5 kinds of non-simple cysts

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12
Q

This kind of cyst contains homogeneous low-level internal echoes with fluid-fluid or fluid-debris levels which react with gravity.

A

complicated

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13
Q

What % of complicated cysts are malignant?

A

0-1.4%

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14
Q

🎗 Two important types of complicated cysts

A
  1. galactocele (milk)

2. sebaceous (sebum)

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15
Q
  1. low to med level echoes
  2. heterogeneous internal appearance
  3. gravity-dependent fluid levels
  4. septations
  5. wall thickening
  6. total or partial wall calcification
  7. partial enhancements or shadowing
A

On sonography, complicated cysts may demonstrate… (7)

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16
Q

🎗 How to tell complicated cysts from complex, intraductal papilloma or papillary carcinoma?

A

No doppler flow will be detected within the debris of a complicated cyst.

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17
Q

🎗 What are the two dynamic ways to eval if a cyst is complicated?

A
  1. jiggle test - see if debris floats around

2. check for gravity dependence - move pt from supine to upright

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18
Q

This kind of cyst contains a solid component.

A

complex

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19
Q

What % of complex cysts are malignant?

A

23%

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20
Q

This kind of cyst is hard to distinguish from a hypoechoic mass.

A

clustered microcysts

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21
Q

This kind of cyst contains one or several internal septations.

A

septated cyst

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22
Q

This kind of cyst has partial or total wall calcification.

A

calcified cyst

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23
Q

🎗 This is a milk-filled cyst caused by obstruction of a lactiferous duct.

A

galactocele

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24
Q

T/F? Galactoceles only affect breastfeeding people.

A

FALSE, both lactating and non-lactating are affected

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25
Q

Where are galactoceles generally located?

A

subareolar

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26
Q
  1. rounded, well-defined mass
  2. hypo to isoechoic
  3. homogenous internal appearance
  4. acoustic enhancement
  5. no internal doppler signal
  6. may also see dilated ducts, mastitis, abscess
A

sonographic appearance: galactocele (6)

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27
Q

🎗 This cyst results from an obstructed sebaceous gland associated with the skin.

A

sebaceous cysts

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28
Q

🎗 Sebaceous cysts contain…

A

sebum, an oily substance

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29
Q

Where are sebaceous cysts generally located?

A

around the Montgomery glands of the areolar or the inframammary fold, very surface

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30
Q
  1. rounded well-defined mass
  2. hypo to isoechoic
  3. superficial location (stand-off pad)
  4. track or stem through dermal layers (‘claw’ sign)
  5. acoustic enhancement
  6. no internal doppler signal
A

Sonographic appearance: sebaceous cyst (6)

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31
Q

🎗 What’s the other name for a sebaceous cyst?

A

epidermal inclusion cyst

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32
Q

This is the term for a wide range of benign changes.

A

fibrocystic changes

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33
Q

This is the most common disorder of the breast accounting for nearly half of all surgical procedures.

A

fibrocystic changes

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34
Q

age range - fibrocystic changes

A

60-90% of females between the ages of 20-40

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35
Q

T/F? Fibrocystic changes are usually unilateral

A

FALSE, bilateral

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36
Q

Mammography identifies fibrocystic changes as an increased ___ of the breast tissue in comparison to a previous study.

A

density

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37
Q
  1. cysts of various size (simple & complicated)
  2. cyst clusters
  3. hyperechoic fibroglandular layer
  4. dilated ducts
A

Sonographic appearance: fibrocystic changes (4)

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38
Q

🎗 This is the classic sonographic appearance of fibrocystic changes.

A

cluster of cysts

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39
Q

Why are fibrocystic changes significant clinically?

A

They produce masses that must be biopsied to differentiate from carcinoma.

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40
Q
  1. bilaterality
  2. multiple nodules
  3. pain prior to menses
  4. greenish discharge
A

Tell-tale characteristics of Fibrocystic changes (4)

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41
Q

🎗 This is the most common benign solid tumor of the breast.

A

fibroadenoma

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42
Q

age range: fibroadenoma

A

20-40

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43
Q
  1. 🎗 rounded
  2. circumscribed
  3. radiopaque (water density)
  4. may have halo
  5. may have calcifications
  6. indistinguishable from a cyst
A

on mammography, a fibroadenoma appears (6)

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44
Q
  1. 🎗 arise from the TDLU
  2. <3 cm
  3. 🎗 more common in African American
  4. pregnancy causes rapid growth
  5. single or multiple
  6. painless, palpable mass
  7. firm or rubbery
  8. moveable, not fixed
  9. 🎗 pseudo-encapsulated (due to compression of adjacent tissues)
  10. necrosis and calcification
A

common characteristics: fibroadenoma (10)

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45
Q
  1. 🎗 rounded
  2. well-defined
  3. mildly hypo or isoechoic
  4. homogeneous
  5. 🎗 thin, echogenic pseudocapsule
  6. 🎗 wider than tall
  7. maybe compressible
  8. edge shadowing
  9. no significant enhancement or shadowing
  10. peripheral/internal doppler flow
A

sonographic appearance: fibroadenoma (10)

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46
Q

🎗 This is seen in adolescent girls and is a highly cellular type of benign fibroadenoma.

A

juvenile (giant) fibroadenoma

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47
Q

Juvenile fibroadenoma tumors grow [slowly/rapidly] and may measure ___.

A

rapidly, >5 cm

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48
Q

This is a benign tumor growing from the ductal epithelium projecting into the lumen of the duct.

A

intraductal papilloma

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49
Q

age range: intraductal papilloma

A

30-55

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50
Q

🎗 What is the most common cause of bloody nipple discharge?

A

intraductal papilloma

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51
Q
  1. typically subareolar
  2. single or multiple
  3. usually < 2 cm
  4. non-palpable
  5. 🎗 may have ‘raspberry’ appearance
  6. tumor may cause duct obstruction
  7. frequent symptom is nipple discharge (serous or bloody)
  8. ductography may be helpful
A

common characteristics: intraductal papilloma

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52
Q

The injection of contrast into the lactiferous duct to demonstrate (or not) filling defects

A

ductogram (galactogram)

53
Q
  1. small solid lesion within the duct
  2. hypo- or isoechoic
  3. rounded or tubular
  4. associated with duct dilatation
  5. radial scanning is optimal
  6. 🎗 doppler signal within the solid component
A

sonographic appearance: intraductal papilloma

54
Q

This is the focal dilatation of a duct caused by an obstructing papilloma. Clinical symptoms are the same as intraductal papilloma.

A

Instracystic papilloma

55
Q
  1. round or oval cyst containing solid mural tumor
  2. tumor appears hypo- or isoechoic
  3. doppler signal within the solid component
A

sonographic appearance: intracystic papilloma

56
Q

🎗 This rare condition is characterized by cysts, duct ectasia, intraductal hyperplasia, and sclerosing adenosis.

A

juvenile papillomatosis

57
Q

This is also known as ‘Swiss Cheese Disease’.

A

juvenile papillomatosis

58
Q

age range: juvenile papillomatosis

A

less than 30

59
Q

This usually presents as a mass located in the periphery of the breast resembling a fibroadenoma, but 25% of patients have a positive family hx of breast cancer.

A

juvenile papillomatosis

60
Q
  1. hypoechoic ill-defined mass
  2. heterogeneous
  3. may have visible cysts and/or duct ectasia
A

sonographic appearance: juvenile papillomatosis

61
Q

🎗 This is an encapsulated tumor of mature adipose tissue

A

lipoma

62
Q

Clinically these are soft compressible mobile masses

A

lipoma

63
Q
  1. radiolucent (fat density)
  2. circumscribed
  3. thin capsule
A

mammography: lipoma

64
Q
  1. oval and well-defined
  2. isoechoic (depending on the density)
  3. homogeneous
  4. 🎗 compressible
  5. usually superficial
  6. may be mistaken for a fat lobule
A

sonographic appearance: lipoma

65
Q

🎗 These are the only breast lesion with a true capsule

A

lipoma

66
Q

🎗 This is a rare type of fatty breast tumor - nonenscapsulated, composed of fat, fibrous and glandular tissues.

A

fibroadenolipoma

67
Q

This is also known as a hamartoma.

A

fibroadenolipoma

68
Q

age range: fibroadenolipoma

A

over 35

69
Q
  1. well-defined, pseudocapsule
  2. oval or lobulated
  3. echogenicity depends on amounts of fat, fibrous, and glandular tissue
  4. possible shadowing
  5. may be quite large
A

fibroadenolipoma

70
Q

This typically arises as a rapidly enlarging palpable mass during pregnancy - benign but usually removed due to size and aggresiveness

A

lactating adenoma

71
Q
  1. large, well-defined mass
  2. lobulated margins
  3. multiple septations within the mass
A

lactating adenoma

72
Q

🎗 This condition causes marked pain, swelling, and redness. The most common form is lactational (puerperal).

A

mastatis (breast inflammation)

73
Q

Severe mastatis may be hard to distinguish from ___ so follow up is necessary.

A

inflammatory carcinoma

74
Q
  1. infected cysts
  2. subareolar abscess
  3. post surgical inflammation
  4. plasma cell (periductal) inflammation
  5. tuberculosis
  6. inflammatory carcinoma
A

non-lactational mastatis

75
Q
  1. firm, tender, swellen breast
  2. localized skin thickening and redness
  3. purulent nipple discharge
  4. tender axillary lymph nodes
  5. leukocytosis and fever
A

signs of mastatis

76
Q
  1. increased echogenicity of subcutaneous fat and parenchymal layers (edema)
  2. possible shadowing due to cellulitis
  3. disrupted ill-defined tissue planes
  4. skin thickening
  5. possible dilated ducts
  6. increased doppler signal
A

sonographic appearance: mastatis

77
Q

🎗 This is a complication of lactational or nonlactational mastatis.

A

abscess

78
Q

An abscess is typically found in the __ region and may require surgical drainage.

A

subareolar

79
Q
  1. complex predominatly cystic mass
  2. thick irregular borders
  3. acoustic enhancement
  4. localized skin thickening
  5. increased doppler signal at the periphery
A

sonographic appearance: abscess

80
Q

🎗 This usually begins with dilated lactiferous ducts. WBC and plasma cells irritate the lining and an infection develops.

A

plasma cell mastitis

81
Q

This is also known as periductal mastitis

A

plasma cell mastitis

82
Q
  1. nipple discharge
  2. palpable hard mass
  3. subareolar location
  4. nipple retraction
  5. possible linear calcifications (rod-shaped on mammo)
  6. breast inflammation
A

common characteristics: plasma cell mastitis

83
Q
  1. dilated ducts with internal debris or wall thickening

2. localized skin thickening

A

sonographic appearance: plasma cell mastitis

84
Q

This is a rare benign lesion of the breast caused by an overgrowth of the stromal tissue.

A

pseudoangiomatous stromal hyperplasia (PASH)

85
Q

age range: PASH

A

reproductive age

86
Q

This may appear as a benign appearing solid mass or an area of architectural distortion.

A

PASH

87
Q

The thickness of breast skin is usually…

A

0.5 to 2.0 mm

88
Q

🎗 This is extremely useful in evaluating skin thickness

A

stand off pad

89
Q

interruption of the dermis layer is suspicous for …

A

carcinoma

90
Q
  1. trauma
  2. benign inflammation
  3. fat necrosis
  4. post surgical scarring
  5. malignancy
  6. radiation therapy treatment
  7. restriction of venous return
A

causes of skin thickening

91
Q

This is bilateral mild discharge from a nonlactating or pregnant person.

A

galactorrhea

92
Q

Galactorrhea may be __-induced or __-induced.

A

endocrine (pituitary adenoma), medication (BCP)

93
Q

This discharge is unilateral, from multiple ducts, and appears pus-y

A

purulent discharge

94
Q

Nipple discharge from breast tumors usually arises from …

A

a single duct and breast lobe

95
Q
  1. intraductal papillary carcinoma (mal)
  2. DCSI (mal)
  3. Invasive ductal carcinoma (mal)
  4. intraductal papilloma (ben)
A

breast tumors that cause nipple discharge

96
Q
  1. serous: clear yellow fluid
  2. serosanguineous: pinkish fluid
  3. sanguineous: red bloody fluid
  4. watery: clear, pale yellow fluid
A

types of discharge that may indicate breast cancer

97
Q

discharge caused by fibrocystic (benign) changes is…

A

green

98
Q
  1. fat necrosis
  2. hematoma
  3. seroma
  4. lymphocele
  5. post operative scarring
A

benign conditions that follow breast trauma

99
Q

This is a thickening or scarring in the fatty tissue that is caused by an injury to the breast

A

fat necrosis

100
Q

🎗 This may simply occur in obese women with fatty pendulous breasts

A

fat necrosis

101
Q

This appears like either an oil cyst or a firm, fixed, spiculated mass

A

fat necrosis

102
Q

This is a blood-filled tumor following direct trauma

A

hematoma

103
Q

The echogenicity of a hematoma depends on…

A

the amount of coagulation. Can be anechoic, complex or hyperechoic

104
Q

This is a localized collection of serous fluid within the breast, usually following a surgical or invasive procedure.

A

seroma

105
Q

Variously as…

  1. simple cyst
  2. free fluid appearance with angular margins
  3. low level internal echoes
  4. thick walled with septations
A

sonographic appearance: seroma

106
Q

This cystic tumor filled with lymph may occur following breast surgery

A

lymphocele (appears like simple or complex cyst)

107
Q

This presents as a palpable mass following breast surgery

A

post operative scarring

108
Q
  1. thin shadow from skin surface
  2. spiculated, fixed, hypoechoic mass with shadowing
  3. no increase flow on doppler
A

sonographic apperance: post operative scarring

109
Q

This benign enlargement of a breast lobule is due to epithelial and stromal hyperplasia.

A

sclerosing adenosis

110
Q

In this condition, the acini of the TDLU increase in number and produce a distorted, spiking, infiltrative appearance.

A

sclerosing adenosis

111
Q

The primary significance of sclerosing adenosis is it’s …

A

ability to mimic cancer.

112
Q
  1. architectural distortion
  2. spiculated appearance
  3. microcalcifications
A

mammographic appearance: sclerosing adenosis

113
Q
  1. irregular spiculated or lobulated mass
  2. hypoechoic
  3. possible shadowing
  4. no increased doppler signal
A

sonographic appearance: sclerosing adenosis

114
Q

This is the invasion of ductal epithelium into the surrounding stromal tissues, not associated with trauma. 🎗

A

radial scar

115
Q

in __% of cases, radial scar is associated with tubular carcinoma.

A

20%

116
Q

Radial scars are usually less than __ cm and non palpable.

A

1 cm

117
Q
  1. spiculated

2. may have calcifications

A

mammo appearance: radial scar

118
Q
  1. irregular spiculated lesion
  2. possible shadowing
  3. no increased doppler signal
A

sono appearance radial scar

119
Q

🎗 This is a rare thrombophlebitis of a superficial bein of the breast.

A

Mondor’s disease

120
Q

Mondor’s disease is usually associated with the ___, affects the ___, and tends to be caused by __.

A

lateral thoracic vein, lateral half, trauma

121
Q
  1. palpable tender cord-like superficial mass

2. fever

A

Mondor’s disease

122
Q
  1. superficial tortuous tubular lesion
  2. anechoic or hypoechoic
  3. stand off pad may be useful
A

sono appearance: Mondor’s disease

123
Q

🎗 Causes of ___

  1. ovarian (enlargement, cyst)
  2. adrenal (tumor, hyperplasia)
  3. thyroid (hypo-)
  4. pituitary (early gonadotropin)
A

precocious puberty

124
Q

🎗 This is the most common cause of precocious puberty.

A

ovarian enlargement and/or hyperstimulation

125
Q

🎗 This is the non neoplastic enlargement of the male breast, may be unilateral or bilat

A

gynecomastia

126
Q

My present as:

  1. breast enlargement
  2. palpable subareolar nodule
  3. breast tenderness/soreness
  4. skin thickening
  5. possible nipple discharge
A

gynecomastia

127
Q

Causes of __:

  1. hormonal changes
  2. estrogen tx of prostate ca
  3. testicular failure
  4. neoplasms (test., adrenal, lung)
  5. chronic disease (liver, renal, pulmonary)
  6. meds (digitalis, antidepressant, antiHTN)
  7. marijuana
  8. Klinefelter’s (XXY)
A

gynecomastia

128
Q

sono appearance:

  1. presence of glandular tissue
  2. poss dilated ducts
  3. increased fat
A

gynecomastia

Breast Sonography (7 decks)

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