Breast Exam Practice Questions 3 Flashcards
(141 cards)
1
Q
What typical benign characteristic does mucinous or colloid carcinoma often demonstrate?
A
Posterior acoustic enhancement
2
Q
When reporting a mammo, the Radiologist describes a mass as having a “breast within a breast” appearance, which is classic for what tumour?
A
Fibroadenolipoma
3
Q
What is another term for fibroadenolipoma?
A
Hamartomas
4
Q
What is the normal thickness of the skin line?
A
Less than 2mm
5
Q
What is common with Paget’s disease?
A
Patents present with scaling and redness of the nipple, often confused with eczema of the nipple
6
Q
What characteristics show with juvenile fibroadenomas?
A
Often displace the nipple
7
Q
What can oil cysts be a result of?
A
Fat necrosis
8
Q
When do oil cysts occur?
A
When traumatized fat cells release their contents into surrounding tissues as sac-like collections of greasy fluid
9
Q
What is the most common abnormality involving the breast?
A
Fibrocystic breast changes
- 50% of all breast lesions
10
Q
What is the most common metastatic lesion from the breast?
A
Metastatic breast cancer from the other breast
- then bone, then lung, then liver
11
Q
What tumour originates from the lining of a lactiferous duct?
A
Papilloma
12
Q
Typically feeling soft, mobile and fleshy with an US appearance of smooth, non-infiltrating borders, medullary carcinoma is often confused clinically with what?
A
FA
13
Q
What effect does a benign mass usually have on fibrous planes within the breast?
A
Benign masses have no effect on adjacent tissue planes
14
Q
What tumour is always considered invasive breast carcinomas?
A
Medullary carcinoma
15
Q
Rad gave a tumour category 5 with Bi-Rads. What is the likelihood the lesion is being for a carcinoma?
A
Highly suggestive of malignancy
16
Q
A well defined, thick walled lesion with a few floating internal echoes and septations most likely represents what on US?
A
An inflammatory cyst
17
Q
What is the most common post surgical breast complication?
A
Seroma
18
Q
How common do seromas have occur post surgery?
A
50-60%
19
Q
What tumour is known to have a higher likelihood of being malignant when they are greater 3cm in size and exhibit cystic spaces?
A
Phyllodes tumour
20
Q
Which type of breast cancer presents histologically with its cells infiltrating surrounding tissue in a uniform, linear arrangement?
A
Invasive lobular carcinoma
21
Q
How is ductal carcinoma in situ (DCIS) typically discovered?
A
Microcalcifications are seen on the mammo
22
Q
What are considered benign mass characteristics? (3)
A
- Smooth contour
2.Thin echogenic capsule - Compressible
23
Q
Polymastia
A
The presence of accessory glandular tissue
24
Q
What is the 2nd most common form of supernumerary breast tissue?
A
Polymastia
25
What percentage can be attributed to FAs for all of benign breast pathologies?
50%
26
What features often differentiates malignant Phyllodes from benign version?
Patients with malignant Phyllodes are typically older than patients with benign Phyllodes benign tumour
27
When does acute infection of the breast occur most often?
During lactation
28
What does the term secondary primaries refer to?
Breast cancer recurrence
29
What are 5 characteristics of simple cysts?
1. Smooth contour
2. Well defined borders
3. Echo free
4. Posterior enhancement
5. This capsule
30
Why must cystic lesions less than 2mm in size must be watched carefully?
They are too small to demonstrate all the characteristics of a simple cyst
31
What pathology is being referred to when they use the term "Swiss cheese" appearance?
Juvenile papillomatosis
32
What characteristics are most consistent with malignancy? (4)
1. Stellate pattern
2. Hypoechogenicity
3. Angular margins
4. Taller than wide
33
Oil cysts can develop from fat necrosis, what kind of appearance can it have?
Egg shell appearance
34
What group of invasive breast cancers have the worse prognosis?
Invasive ductal carcinoma (NOS)
35
What vascular characteristics of a breast mass would lead to believe its malignant?
Hypervascular with approx 30% of its volume made up of vessels
36
Is lobular carcinoma in situ (LCIS) a true cancer?
No
37
Is a lipoma or FA more compressible?
A lipoma is more compressible
38
A patient presents with a previous history of Burkitt's and multiple, palpable masses in the right axilla. A hypoechoic mass with irregular borders is identified in the right breast. What tumour is the first possibility for a diagnosis?
Breast lymphoma
39
Which type of breast cancer contains both glandular and non-glandular patterns with an epithelial or mesenchymal tissue component?
Metaplastic carcinoma
40
What type of patient is LCIS most often appearing in?
Premenopausal women
41
Micro and macro breast disease makes up what % of all lesions identified clinically or on mammo?
25%
42
What is the most common benign, soft tissue tumour of the breast?
Lipoma
43
What is the most common type of invasive carcinoma?
Invasive ductal carcinoma
44
What % does invasive ductal carcinoma make up?
65-80%
45
What kind of breast malformation is when a patient born with a breast that does not include a nipple or areola but does contain glandular tissue?
Athelia
46
When can tubular adenomas often be differentiated from FA's based on US characteritics?
Presence of tightly packed, punctate calcifications
47
What best describes multicentric breast carcinoma?
All the tumours formed separately in different areas of the breast
48
Do FA's become malignant?
Rarely
49
What age group are FA's most common in?
35 and under
50
What condition is most commonly precipitated by milk stasis?
Puerperal mastitis
51
What is another term for acute mastitis?
Puerperal mastitis
52
What is chronic mastitis caused by?
Thickening of the connective tissue surrounding the lactiferous ducts, forcing secretions into the periductal tissues
- inflammation of glandular tissue
53
What quadrant has the highest % of malignant breast tumours? Whats the %?
1. UOQ
2. 50%
54
What kind of features could make a lymph node suspicious for malignancy? (4)
1. Single node
2. Round appearance
3. Absent of hilar echoes
4. Thick cortex
55
What kind of echogenicity is typically considered benign?
Hyperechoic
56
What kind of vascularity is seen with malignant tumours? (5)
1. Multiple shunts
2. Lots of vessels
3. Multiple tortuous vessels
4. 5 or more intratumoral vessels
5. 25% or more vessel percentage related to tumor volume
57
A patients mammo displays a new, fairly well circumscribed density in the UOQ of her breast. The findings are likely reported in what kind of Bi-Rads category?
0
- needs more imaging to characterize
58
What are 3 suspicious findings for a malignant solid breast pathology?
1. Phyllodes tumour with cystic spaces
2. Greater than 3cm in size
3. Found in a Pt over 45 years of age
59
What is the most common cause of blood nipple discharge?
Papillomas
60
A patient presents with a fever and a painful, swollen breast. The overlying skin is red and warm to touch. US demonstrates a complex fluid collection. What pathology is this most likely?
Abscess
61
What type of breast cancer is considered a specialized type of invasive ductal carcinoma?
Tubular carcinoma
62
What type of pathology is defined as epithelial proliferation that is still confined to the terminal duct lobular unit (TDLU)?
Non-invasive carcinoma
- has not yet invaded surrounding tissue
63
A patient with known intraductal carcinoma presents with an additional rare form of breast cancer that is limited tot he nipple and areola. Patient symptoms include a crusty nipple and blood nipple discharge. What is her pathology?
Paget's disease of the nipple
64
Multifocal breast cancer
Multiple foci of cancer in the same quadrant of the breast
- cancer in the vicinity of or within the same quadrant
65
What is the current average of local breast cancer recurrence rate at 5 years following lumpectomy?
4%
66
Post lumpectomy surgical scars are carefully monitored for tumour recurrence. What features might make them suspicious?
The size of the scar increases after 2 stable exams
67
A 56 year old Pt presents with a palpable lump. Her previous mammo visualized a round 3cm mass demonstrating a water density. US visualized a round anechoic lesion with acoustic enhancement and no vascualrity. What Bi-Rads category would this fall in?
2
- benign
68
How does breast tissue appear in a lactating patient vs a non-lactating patient? (2)
1. More dense
2. More echogenic
69
What type of calcification is considered most suspicious for malignancy of the breast?
Fine linear pleomorphic calcifications
70
What type of calcification is considered intermediate concern in the breast?
Coarse heterogeneous calcifications
71
What type of calcification is considered benign in the breast? (2)
1. Diffusely scattered dystrophic calcifications
2. Plasma cell mastitis calcifications
72
A 28 year old lactating patient develops an echo free lesion with posterior acoustic enhancement that may persist for years, transforming into an oil cyst. What lesion is this most likely?
Galactocele
73
What can an oil cyst mimic the appearance of?
Carcinoma
74
What are the features of an oil cyst that can mimic a carcinoma? (3)
1. Firm
2. Shadowing
3. Irregular mass
75
How is Mondor's disease of the breast characterized?
Thrombophlebitis of the subcutaneous veins of the breast
76
77
What is LCIS considered a marker for?
Increased risk of breast carcinoma
78
What is LCIS considered a true cancer?
No
79
Where is LCIS typically found?
In lobules in the breast rather than the ducts
80
What type of invasive carcinomas is usually associated with a focus of ductal carcinoma in situ (DCIS) that demonstrates as a small spiculated mass and is characterized microscopically by relatively uniform angulated small ducts which invade mammary stroma?
Tubular carcinoma
81
Which of the following describes the spread of metastatic breast cancer from most common to least common? (4)
1. Contralateral breast
2. Bone
3. Lung
4. Liver
82
What % of cancers are located in the retroareolar region?
17%
83
What % of cancers are located in the UIQ?
15%
84
What % of cancers are located in the LOQ?
10%
85
What does category 3 mean with Bi-Rads?
Probably benign
86
What can be mistaken as a pseudomass?
Fibrous ridge
87
What is the most commonly palpated pseudomass of the breast?
Fibrous ridge
88
What kind of effect do malignant tumours have on the fibrous planes? (2)
1. Tissue plane converge towards the mass
2. Disrupt tissue planes
89
What age are cysts most commonly found in women?
35-54 years
90
Where are solitary papillomas usually located?
Subareolar region
91
What % of FA's have a complex appearance?
33%
92
What symptom can be a result of breast trauma? (6)
1. Contusion
2. Hematoma
3. Fat necrosis
4. Seroma
5. Skin thickening
6. Scarring
93
Why do FA's often significantly increase in volume during pregnancy and lactation?
They are affected by rising estrogen levels
94
A patient presents with a palpable, superficial lump in her medial breast. US reveals a hypoechoic lesion with some through transmission within the dermal layer. A small tract is seen extending to the skin surface. What is this Pts most likely diagnosis?
An epidermoid inclusion cyst
95
What is another term for an epidermoid inclusion cyst?
Sebaceous cyst
96
What does category 1 mean for Bi-Rads?
The mammo or US does not demonstrate any pathology
97
What types of implants are associated with anaplastic large cell lymphoma (BIA-ALCL)?
Textured surface implants
98
Duct extension
Tumour extends in a single duct TOWARDS the nipple
99
Branch pattern
Extension from the tumor into small ducts leading AWAY from the nipple
100
What is the most common form of supernumerary breast tissue?
Polythelia
101
Polythelia
More than 2 nipples
102
What characteristic indicates the highest positive predictive value for malignancy?
Angular margins
103
What are the risk factors for breast cancer? (8)
1. Dense breasts
2. Family history of breast cancer
3. History of atypical ductal hyperplasia
4. Previous history of breast cancer
5. Postmenopausal obesity
6. Nulliparity
7. Late first term pregnancy
8. History of high dose radiation exposure
104
A 67 year old Pt presents complaining of a palp lump in her Lt breast 9:00 3A. Visualization of the mass requires a standoff pad, and a defect in the 2nd skin line is demonstrated. What is the mass most likely?
Sebaceous cyst
- epidermal inclusion cyst
105
What is the name of the lesion that is oval macrolobulated with fibrotic septae that can grow rapidly and will most likely regress when lactation ceases?
Lactating adenoma
106
What can periductal mastitis be confused with?
Duct ectasia
107
What can cause skin thickening of the breast? (10)
1. Radiation therapy
2. Surgical scarring
3. Carcinoma
4. Trauma
5. Inflammation
6. Edema
7. Venous obstruction
8. Lymphatic obstruction
9. Congestive heart failure
10. Nephrotic syndrome.
108
A 28 year old patient presents in the department with multiple firm to hard palpable lumps that are easily moveable. She is a Type 1 diabetic. What does she most likely have?
Diabetic fibrous mastopathy
109
What % of intraductal carcinomas form a stellate configuration?
66%
110
What % of intraductal carcinomas have an oval shape?
33%
- more favorable outcome
111
A 25 year old patient presents with a soft, mobile, fleshy, circumscribed tumour. The tumour grew very quickly and originally was considered to be a FA. After BX what is the most likely diagnosis?
Medullary carcinoma
112
What type of tumour is often confused with an FA?
Medullary carcinoma
113
What is the most common extramammary metastases to the breast?
Malignant melanoma
114
What should be included in the routine US protocol for Pts with a history of breast cancer who have had a lumpectomy?
Bilateral assessment of regional lymph nodes
115
Where do benign lesions usually lay in reference to the chest wall?
Parallel to the chest wall
116
What is Peau d'Orange caused by?
A blockage of lymph glands due to an underlying cancer
117
Where is the most common location for supernumerary breast tissue? How much?
1. Abdomen
- thoracic or abdominal sections of the milk line
2. 2/3rds
118
Where is the 2nd most common location for supernumerary breast tissue?
Axilla
119
What size should an FA be in order to biopsy it?
4cm
120
A 14 year old patient presents with nipple discharge and a painless palpable nodule in the subareolar region. She has a family history if breast cancer. What is this lesion mostly likely to be?
Juvenile papillomatosis
121
What kind of Pt is fat necrosis most common in? (2)
Obese women with large breasts
122
On US a mass appear hypoechoic with angular margins and posterior acoustic enhancement. What is the most likely diagnosis for the lesion?
A high grade invasive ductal carcinoma
123
What are the 2 most common US characteristics seen in high grade breast carcinomas?
1. Angular margins
2. Posterior acoustic enhancement
124
Posterior acoustic enhancements is common is what kinda of cancer?
High grade
125
What is the most aggressive form of ductal carcinoma in situ (DCIS)?
Comedo carcinoma in situ
126
A 54 year old patient with a history of normal routine mammo for 10 years presents with a hypoechoic mass with angular margins. Biopsy proves the cells of the mass present in a uniform, linear arrangement. No microcalcifications were visualized on prior mammos. What is the mass most likely?
Invasive lobular carcinoma
126
What is the name of the lymphoma found in pregnant and lactating women that has a poor prognosis?
Burkitt's lympoma
127
What term describes "the absence of the nipple and areolar in the presence of glandular tissue"?
Athelia
128
What kind of orientation do malignant lesions have?
Vertical orientation
- taller then wide
129
What makes a malignant mass, "firm, or hard and gritty"?
Fibroelastic host response
- reactive fibrosis happens when tumours invade surrounding tissue
130
What invasive breast carcinoma has an excellent prognosis with lymph node involvement being uncommon?
Adenoid cystic carcinoma
131
Adenosis
Proliferation of the ductules and lobules
132
What type of cyst demonstrates a teacup appearance?
Milk of calcium cyst
133
What are more compressible, lipomas of FA's?
Lipoma's
133
A 15 year old patient presents with a rapidly growing mass which stretches her skin. What could this lesion most likely represent?
Juvenile fibroadenoma
134
What is the solid, benign breast mass that displays tightly packed, punctate calcifications scattered throughout the breast?
Tubular adenoma
135
What % do lipoma's compresses?
30%
136
What is another term for sclerosing duct hyperplasia?
Radial scar
137
What is the receptor type associated with the lowest recurrence rate after 5 years in patients who had a lumpectomy?
Triple-positive disease
138
What is the receptor type associated with the highest recurrence rate after 5 years in patients who had a lumpectomy?
Triple-negative disease
139
What is the underlying cause of radial scars?
Unknown
