Breast- Disease Clinical Manifestation

Question 1

The most common symptoms reported by women are _________________ ( Fig. 23-3 ).

Asymptomatic women with abnormal
findings on mammographic screening also require further evaluation.

Answer 1

1. pain,
2. a palpable mass, “lumpiness”(without a discrete mass),
3. or nipple discharge

Question 2

_________________ is a common symptom that may be cyclic with menses or
noncyclic.

Answer 2

Pain (mastalgia or mastodynia)

Question 3

​ ____________has no pathologic correlate, and most effective treatments target
hormone levels.

Answer 3

Diffuse cyclic pain

Question 4

_________________ is usually localized to one area of the breast.

Answer 4

Noncyclic pain

Question 5

Noncyclic pain causes are:

Answer 5

Causes include

• ruptured cysts,
• physical injury,
• and infections
• , but most often no specific lesion is identified.

Question 6

Although roughly 95% of painful masses are benign, it must be remembered that about ____________-of
breast cancers are painful.

Answer 6

10%

Question 7

____________ are also common and must be distinguished from the normal
nodularity (or “lumpiness”) of the breast.

Answer 7

Discrete palpable masses

Question 8

What are the most common palpable lesions are invasive
carcinomas, fibroadenomas, and cysts.

Answer 8

• invasive carcinomas
• , fibroadenomas,
• and cysts

Question 9

A breast mass generally becomes palpable when it is at
least _____________.

Answer 9

2 cm in size

Question 10

Palpable masses are most common in ______________ ( Fig. 23-4 ),
but the likelihood of a palpable mass being malignant increases with age.

For example, only
10% of breast masses in women under age 40 are malignant as compared with 60% of masses
in women over age 50.

Answer 10

premenopausal women

Question 11

Approximately 50% of carcinomas arise in the________________-

Answer 11

upper outer quadrant,

Question 12

Approximately arise in the10% in each of the _____________

Answer 12

remaining quadrants,

Question 13

Approximately arise about 20% in the _________________-

Answer 13

central or subareolar region.

Question 14

_____________ is a less common finding that is most worrisome when it is spontaneous and
unilateral, since it might be from an underlying carcinoma.

Answer 14

Nipple discharge

Question 15

When is a nipple discharge become most worrisome?

Answer 15

spontaneous and
unilateral,

*****since it might be from an underlying carcinoma.

Question 16

A small discharge is often produced
by the_______________

Answer 16

manipulation of normal breasts.

Question 17

Milky discharges (galactorrhea) are associated with

NOTE : Repeated nipple stimulation can also induce
lactation (a method sometimes used by women who wish to breastfeed adopted infants).
Galactorrhea is not associated with malignancy.

Answer 17

• elevated prolactin levels (e.g., by a pituitary adenoma),
• hypothyroidism,
• or endocrine anovulatory syndromes,
• and can also occur in patients taking oral contraceptives,
• tricyclic antidepressants,
• methyldopa,
• or phenothiazines.

Question 18

Bloody or serous discharges are also most commonly associated with benign conditions, but in
a significant minority of cases can be a sign of malignancy.

The most common etiologies are
_________________

Answer 18

solitary large duct papillomas and cysts

Question 19

. Benign bloody discharges may also occur during pregnancy, possibly as a result of the _____________

Answer 19

rapid growth and remodeling of the breast.

Question 20

​ The risk of
malignancy with discharge increases with age,

since it is associated with carcinoma in 7% of
women younger than 60 years and in 30% of women older than 60 years (see Fig. 23-4 ).
There is considerable interest in using induced nipple discharges as a source of cells and DNA
for noninvasive cytologic and molecular breast cancer screening tests.

Question 21

Mammographic screening was introduced in the 1980s as a means to detect small, nonpalpable, asymptomatic breast carcinomas (discussed later).

The sensitivity and specificity
of mammography increase with age, as a result of replacement of the fibrous, radiodense tissue
of youth with the fatty, radiolucent tissue of the elderly (see Fig. 23-2 ).

At age 40, the
probability that a mammographic lesion is cancer is only 10%, but this rises to greater than 25%
in women over 50 (see Fig. 23-4 ). \

The principal mammographic signs of breast carcinoma are
_________________________

Answer 21

densities and calcifications:

Question 22

. Mammographic densities are produced most commonly by _____________(see Fig. 23-4 ).

Most neoplasms are radiologically
denser than the intermingled normal breast tissue.

The value of mammography lies in its
ability to identify small, nonpalpable cancers.

For example, the average size of an
invasive carcinoma detected by mammography (1.1 cm) is less than half that of
carcinomas detected by palpation (2.4 cm).

Answer 22

• invasive carcinomas,
• fibroadenomas,
• or cysts

Question 23

Calcifications form on______________.

Answer 23

• ** secretions,**
• necrotic debris,
• or hyalinized stroma

Question 24

Benign calcifications are often associated with ____________

Answer 24

• clusters of apocrine cysts,
• hyalinized fibroadenomas,
• and sclerosing adenosis.

Question 25

. Calcifications associated with malignancy are usually\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 25

* small, * irregular, * numerous, * and clustered nmemonics : **Parang Grapes!!!!**

Question 26

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is **most commonly detected** as **mammographic calcifications**, which are **often deposited in a linear, branching pattern as the carcinoma fills the ductal system.**

Answer 26

.. Ductal carcinoma in situ (DCIS)

Question 27

Ductal Ca in situ is most commonly detected as** mammographic calcifications**, which are often deposited in a ______________ pattern as the carcinoma fills the ductal system. ## Footnote

Answer 27

linear, branching

Question 28

Mammographic screening has **increased the number of breast cancers diagnosed as DCIS** (see Fig. 23- 13 ) ** Invasive carcinomas** presenting as **calcifications without an accompanying radiodensity**are**uncommon,** generally small in size, and rarely associated with lymph node metastases

Question 29

In about **10% of cases**, **carcinomas are missed b**y **mammography**. The principal causes of these failures are the.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **The inability to image a palpable mass does not indicate that it is benign, and all palpable masses require further investigation**

Answer 29

* presence of surrounding radiodense tissue (especially in younger women) that obscures the tumor, * the absence of calcifications, * small size, * a diffuse infiltrative pattern with little or no desmoplastic response, * or a location close to the chest wall or * in the periphery of the breast

Question 30

Other imaging modalities are **useful adjuncts**. \_\_\_\_\_\_\_\_\_\_\_\_\_\_- distinguishes between **solid and cystic lesions**and**can define more precisely the borders of solid lesions**.

Answer 30

Ultrasonography Note: Most palpable masses that **are not imaged by mammography** are **detectable by ultrasound.**

Question 31

UTZ advanatage over mammography is

Answer 31

1. distinguishes solid vs cyst 2. define more precisely the border of solid lesion

Question 32

\_\_\_\_\_\_\_\_\_\_\_ detects cancers by the **rapid uptake of contrast agents due to increased tumor vascularity and blood flow.**

Answer 32

**Magnetic resonance imaging (MRI)**

Question 33

What are the indications of MRI?

Answer 33

1. It is useful in **screening for cance**r in **women with dense breasts** 2. or at** very high risk for cancer** 3. , in determining the **extent of chest wall invasion** by **locally advanced cancers,** 4. and in the **evaluation of breast implant rupture**. Note : A **high rate of false-positive results** l**imits its usefulness** in **screening women outside of these groups.**