The most common symptoms reported by women are _________________ ( Fig. 23-3 ).
Asymptomatic women with abnormal
findings on mammographic screening also require further evaluation.
- a palpable mass, “lumpiness”(without a discrete mass),
- or nipple discharge
_________________ is a common symptom that may be cyclic with menses or
Pain (mastalgia or mastodynia)
____________has no pathologic correlate, and most effective treatments target
Diffuse cyclic pain
_________________ is usually localized to one area of the breast.
Noncyclic pain causes are:
- ruptured cysts,
- physical injury,
- and infections
- , but most often no specific lesion is identified.
Although roughly 95% of painful masses are benign, it must be remembered that about ____________-of
breast cancers are painful.
____________ are also common and must be distinguished from the normal
nodularity (or “lumpiness”) of the breast.
Discrete palpable masses
What are the most common palpable lesions are invasive
carcinomas, fibroadenomas, and cysts.
- invasive carcinomas
- , fibroadenomas,
- and cysts
A breast mass generally becomes palpable when it is at
2 cm in size
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.
Approximately 50% of carcinomas arise in the________________-
upper outer quadrant,
Approximately arise in the10% in each of the _____________
Approximately arise about 20% in the _________________-
central or subareolar region.
_____________ is a less common finding that is most worrisome when it is spontaneous and
unilateral, since it might be from an underlying carcinoma.
When is a nipple discharge become most worrisome?
*****since it might be from an underlying carcinoma.
A small discharge is often produced
manipulation of normal breasts.
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.
- elevated prolactin levels (e.g., by a pituitary adenoma),
- or endocrine anovulatory syndromes,
- and can also occur in patients taking oral contraceptives,
- tricyclic antidepressants,
- or phenothiazines.
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
solitary large duct papillomas and cysts
. Benign bloody discharges may also occur during pregnancy, possibly as a result of the _____________
rapid growth and remodeling of the breast.
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.
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
densities and calcifications:
. 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).
- invasive carcinomas,
- or cysts
Calcifications form on______________.
- necrotic debris,
- or hyalinized stroma
Benign calcifications are often associated with ____________
- clusters of apocrine cysts,
- hyalinized fibroadenomas,
- and sclerosing adenosis.
. Calcifications associated with malignancy are
- and clustered
nmemonics : Parang Grapes!!!!
most commonly detected as mammographic calcifications, which are often deposited in
a linear, branching pattern as the carcinoma fills the ductal system.
.. Ductal carcinoma in situ (DCIS)
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.
screening has increased the number of breast cancers diagnosed as DCIS (see Fig. 23-
Invasive carcinomas presenting as calcifications without an accompanying
radiodensity are uncommon, generally small in size, and rarely associated with lymph
In about 10% of cases, carcinomas are missed by 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
- 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
Other imaging modalities are useful adjuncts.
______________- distinguishes between solid and
cystic lesions and can define more precisely the borders of solid lesions.
Note: Most palpable masses
that are not imaged by mammography are detectable by ultrasound.