Breast

Question 1

Benefits of a true lateral view and a rolled CC view ?

Answer 1

A true lateral view can help demonstrate suspected teacup calcifications are teacup calcifications. Compression views are used to interrogate suspicious calcifications seen on mammograms further.

A rolled CC view can help separate out structures to prove that the ‘mass’ seen on the original mammogram was a summation shadow, or to confirm the presence of a mass.

Question 2

Fibrocystic breast disease features?

Question 3

Features of oil cyst?

Answer 3

Fatty tissue necrosis

Acutely:
Superficial fluid collection with surrounding ↑ echogenicity due to edema on US

Oil cyst(s): Circumscribed lucent round mass ± rim Ca⁺⁺ on mammograph

‘Egg shell’ Calcification

MRI = shows central hyperintense fat on T1 and rim of peripheral enhancement

Question 4

What primary cause breast mets?

Answer 4

Lymphoma
Melanoma
Ovarian
Lung

Question 5

Benign breast lesion that can classically rapidly increase in size?

Answer 5

Phyllodes Tumour
40s
Well Circumscribed solid mass without Ca⁺⁺

Cant readily be distinguished from fibroadenoma on imaging = Bx Fibroepithelial

5-10% risk of malignant transformation

Axillary mets are rare, haematogenous spread to the lung, pleura and bone

DDX
Fibroadenoma
Typically occurs in younger women (peak age: 25-30)
Commonly have Ca⁺⁺;

Question 6

Indications for breast MRI?

Answer 6

Axillary mets and no primary visible on mammography
Dense breasts and high risk of LCIS
+ve BRCA screen
Assessment of response to neoadjuvant chemotherapy
Suspected multifocal carcinoma

Nb. Sensitvity for DCIS is poor

Question 7

Intracapsular vs extracapsulat implant rupture. what signs?

Answer 7

Intracapsular
- Linguine on MRI
- Stepplader on US

Extracapsular
- Snowstrom on US

Water-suppressed STIR: Only silicone is bright
Depict extracapsular silicone, extent

Question 8

Feature of fibroadeoma?

Answer 8

Well circumsribed, homogeneous, slightly hypoechoic or isoechoic, circumscribed, oval mass

Popcorn-shaped, very dense, large Ca⁺⁺

Mild posterior acoustic enhancment (not as much as cyst)

MR =Non-enhancing internal septations

Question 9

Large well circumscribed, mixed density mass (including Fat and Ca”+), ‘breast within a breast’ apperance?

Answer 9

Hamartoma/fibroadenolipoma

Question 10

Intraductal mass or intracystic mass , Often mammographically occult, especially if central.Periareolar/retroareolar. Bloody or spontaneous clear nipple discharge

Answer 10

Papilloma

Question 11

Fat-containing, circumscribed mass; nondependent fat on US, fat-fluid level on 90° lateral mammogram. History of lactation.

Answer 11

Galactocele

Early can just be radioopaque lesion if water density.
Later mixed density with a Fat-water level.

Question 12

Pagets disease is accociated with which breat cancer?

Answer 12

Adenocarcinoma of epidermis of nipple
Erythema, flaking and ulceration of skin of nipple
Associated with high grade DCIS

Question 13

Thrombophlebitis of the subcutaneous veins of the breast and anterior chest wall?

Answer 13

Mondor Disease
Underlying breast cancer in 12%

Question 14

Large, thick ‘rod like’ calcifcations symmtetricl in both breasts radiating towards the nipples

Answer 14

Plasma cell mastitis

Question 15

Types of benigin calcifcations in breast ?

Answer 15

Dermal
vascular
coarse popcorn-like
large rod-like
Round - Fibrocystic changes (tea cup), FA
rim dystrophic - Fat necrosis
suture

Malignant Ca⁺⁺ are typically finer, focal, unilateral

Question 16

freely mobile, homogenous hypoechoic or isoechoic solid mass with
posterior acoustic enhancement (most common) and septa. thrid trimester?

Answer 16

Lactating adenoma

regresses post pregnancy

Top Differential Diagnoses

-Fibroadenoma
Common in adolescents and women < 30 years of age
Clinically smooth, firm or rubbery, freely movable
painless
FA typically firm (not compressible), whereas lactating adenoma typically soft (compressible)

Hypoechoic, solid, circumscribed, oval or gently lobulated mass on US
Can enlarge during pregnancy
May have coarse heterogeneous or popcorn Ca⁺⁺

-Galactocele:
Benign breast mass that contains retained milk
Circumscribed mass with fluid-debris level
Echogenic debris may layer in nondependent portion due to fat content of milk = Fat fluid level
Fat-containing, circumscribed mass on mammography
Presentation may be delayed
6-10 months after cessation of nursing
Aspiration diagnostic and curative
Painless