Chapter 21 Breast

Question 1

acinus (acini)

Answer 1

Glandular (milk-producing) component of the breast lobule

Question 2

areola

Answer 2

The pigmented skin surounding the breast nipple

Question 3

axilla

Answer 3

armpit

Question 4

breast

Answer 4

differentiated apocrine sweat gland with a functional purpose of secreting milk during lactation

Question 5

Cooper’s ligaments

Answer 5

connective tissue septa that connect perpenndicularly to the breast lobules and extend out to the skin

Question 6

mammary layer

Answer 6

middle layer of the breast tissue that contains the ductal, glandular, and stromal portions of the breast

Question 7

retromammary layer

Answer 7

deepest of the three layers of the breast noted on breast ultrasound

Question 8

subcutaneous layer

Answer 8

most superficial of the three layers of the breast identified on breast ultrasound

Question 9

tail of Spence

Answer 9

normal extension of breast tissue into the axillary region

Question 10

The primary function of the breast is ______ transport.

Answer 10

fluid

Question 11

The _______ system is critical in the transport of fluids withing the breast.

Answer 11

ductal

Question 12

An important function during the reproductive years is for the breast to make _______ from nutrients and water taken from the bloodstream.

Answer 12

milk

Question 13

Milk is produced within the _______ and carried to the nipple by the ducts.

Answer 13

acini

Question 14

Breast development begins before _______ and continues until the patient is approximately 16 years old.

Answer 14

menarche

Question 15

During this time of development, the ductal system proliferates under the influence of ______.

Answer 15

estrogen

Question 16

During pregnancy, acinar development is accelerated to enable milk production by estrogen, ________, and prolactin.

Answer 16

progesterone

Question 17

The hormone produced by the pituitary gland that stimulates the acini to produce and excete milk is called ________.

Answer 17

prolactin

Question 18

The expulsion of the placenta after the birth of a baby causes a drop in circulating progesterone, initiating ______ production within the breasts.

Answer 18

milk

Question 19

The physical stimulation of suckling by the baby initiates the release of _________ (produced by the hypothalamus and released by the pituitary gland), which further incites prolactin secretion, stimulating additional milk production.

Answer 19

oxytocin

Question 20

Full maturation of the acini occurs during lactation and is though to be mildly protective against the development of breast ________.

Answer 20

cancer

Question 21

Ultrasound may be used for screening purposes in _______ breast that are ______ and difficult to penetrate by mammagraphy, to evaluate palpable masses that are not visible on a mammogram, and to image the deep juxtathoracic tissues not normally visible by mammography.

Answer 21

young, dense

Question 22

Ultrasound is also useful in ______ structures within uniformly dense breast tissue where mammography is limited (e.g., in differentiating solid, round masses from fluid-filled cysts and visualizing tissue adjacent to implants or other structures that limit visualization by mammography).

Answer 22

differentiating

Question 23

A(n) ______ aspiration can be performed to determine whether a lesion is a complex cyst or truly a solid mass.

Answer 23

cyst

Question 24

What basic linical information must the sonographer have for any patient referred for breast ultrasound?

Answer 24

patients age, risk factors for breast cancer, symptoms, location and clinical impression of any lumps

Question 25

Pertinent clinical information that should be provided by the referring pysician includes size and location of the lump, when it was noticed, and its relation to the _______.

Answer 25

menstral cycle

Question 26

The breast is a modified _______ gland located in the superfiial fascia of the anterior chest wall.

Answer 26

sweat

Question 27

Sonographically the breast is divided into three layers located between the skin and the pectoralis major muscle on the anterior chest wall. These layers are the ______ layer, the ________ layer, and the __________ layer.

Answer 27

subcutaneous, mammary, retromammary

Question 28

Fat is the least __________ tissue within the breast.

Answer 28

echogenic

Question 29

The fatty tissue appears ______, whereas the ducts, glands, and suporting ligaments appear echogenic.

Answer 29

hypoechoic

Question 30

The _________ quadrant of the breast contains the highest concentration of lobes.

Answer 30

upper outer

Question 31

Each lobule contains ______ (milk-producing glands) that are clustered on the terminal ends of the ducts like grapes on a vine.

Answer 31

acini

Question 32

The _________ muscle lies porterior to the retromammary layer.

Answer 32

pectoralis major

Question 33

The __________ tissue can situate itself in and amoung the areas of glandular tissue, and in some scanning planes it can mimic isoechoic or hypoechoic masses.

Answer 33

adipose or fatty

Question 34

Sonographically, cancers can be difficult to differentiate in the fatty breast because most cancers appear _______ and can be difficult to differentiate from the normal breast tissue.

Answer 34

hyoechoic

Question 35

The main arterial suppy to the breast comes from the internal _____ and the lateral ________ artery.

Answer 35

mammary, thoracic

Question 36

Lymphatic drainage from all parts of the breast generally flows to the _______ lymph nodes.

Answer 36

axillary

Question 37

A dominant cyst is frequently _______ or _______ (long axis toward nipple), smooth, soft (some cysts under tension can be firm and are usually very tender),and easily movable.

Answer 37

round, oval

Question 38

Fibroadenomas are usually similar in shape, but they are often quite firm and rubbery in consistency and _________ on ultrasound.

Answer 38

homogeneously solid

Question 39

Breast cancer is usually lobular or ________ in shape, uneven in surface contour (sometimes gritty in texture), and fixed or oorly movable.

Answer 39

irregular

Question 40

Most breast masses that arise during the adolescent years are _______.

Answer 40

fibroadenomas

Question 41

A(n) _______ implant rupture occurs when there is a breach of the membrane srrounding an implant, but the silicone that leaks out is still confined within the fibrous scar tissue that forms a "capsule" around the implant.

Answer 41

inracapsular

Question 42

As the implant collapses and the membrane folds inward, a series of discontinuous echogenic lies parallel to the face of the transducer may be seen and are referred to as the "stepladder sign" or "_________ sign."

Answer 42

linguine

Question 43

The use of the __________ positions is unique to the breast and can often pick up subtle abnormalities extending toward the nipple along the ductal system from the mass.

Answer 43

radial/antiradial

Question 44

___________ tend to grow within the ducts and will often follow the ductal system in a radial plane, toward the convergency at the nipple.

Answer 44

Malignancies

Question 45

To be considered a simple cyst, a lesion must meet which three criteria on ultrasound?

Answer 45

Must be devoid of internal echoes (anaechoic), show smooth inner margins with an imperceptible capsule, and demonstrate posterior acoustic enhancement.

Question 46

A rounded or oval shape is usually associated with ________ lesions, whereas sharp, angular margins are associated with ______ lesions.

Answer 46

benign, malignant

Question 47

The normal tissue planes of the breast are ______ oriented.

Answer 47

horizontally

Question 48

Benign lesions tend to grow within the normal tissue planes, and their long axis lies ______ to the chest wall.

Answer 48

parallel

Question 49

Malignant lesions are able to grow through the connective tissue and may have a(n) ______ orientation when imaging the breast from anterior to posterior.

Answer 49

vertical

Question 50

If a mass measure longer in the anteroposterior dimension (__________) than in either transverse or sagittal planes (_______), the mass has a vertical orientation that is usually described as being "taller than wide" and is suspicious for malignancy.

Answer 50

height, width

Question 51

Malignant masses will often demonstrate increased ________ within the lesion and often have a feeder vessel, which can be identified with careful evaluation.

Answer 51

vascularity

Question 52

Lesions more common to younger women are _______ disease and fibroadenomas.

Answer 52

fibrocystic

Question 53

Older or postmenopausal women are more likely to have __________ papillomas, duct ectasia, and cancer.

Answer 53

intraductal

Question 54

Skin dimpling or ulceration and nipple retraction nearly always result from _______.

Answer 54

cancer

Question 55

Benign tumers are rubbery, ________, and well delineated (as seen in a fibroadenoma), whereas malignant tumors are often stone had and irregular with a gritty feel.

Answer 55

mobile

Question 56

Clinical signs and symptoms of _________ include the lumps and pain that the patient feels that fluctuate with every monthly cyle. In most cases both breast are equally involved.

Answer 56

fibrocystic condition

Question 57

The growth of a fibroadenoma is stimulated __________.

Answer 57

estrogen

Question 58

Sonographically, fat necrosis appears as an irregular, complex mass with low-level echoes, may mimic a(n) _________ lesion, and may appear as fat, but is separate and different from the rest of the breast parenchyma.

Answer 58

malignant

Question 59

____________ may result from infection, trauma, mechanical obstruction in the breast ducts, or from other conditions. It often occurs during lactation, beginning in the lactiferous ducts and spreading via the lymphatics or blood.

Answer 59

acute mastitis

Question 60

An intraductal papilloma is a small, ________ tumor that grows within the acini of the breast.

Answer 60

benign

Question 61

In ________ tissue, most cancer growth occurs along the borders.

Answer 61

fibrotic

Question 62

_________ and _________ are frequently used as pathways for new tumor development.

Answer 62

lymphatics, blood bessels

Question 63

If the tumor is __________, it continues to grow in one area, compressing and distorting the surrounding architecture.

Answer 63

encapsulated

Question 64

Most cancer originates in the ________ ductal lobular units, whereas a smaller percentage originates in the glandular tissue.

Answer 64

terminal

Question 65

___________ refers to breast tumors that arise from the epithelium, in the ductal and glandular tissue, and usually have tentacles.

Answer 65

Carcinoma

Question 66

Breast carcinomas are generally categorized by two factors: where the cancer cells originate (___________ or ___________) and whether the cancer is prone to spreading (___________ or __________).

Answer 66

ductal, lobular, noninvasive, invasive

Question 67

Carcinomas that do not normally spread outside of the duct or lobule are called noninvasive, noninfiltrating, or _______ caners, whereas cancers that spread into nearby tissue are said to be invasive or infiltrating.

Answer 67

in situ

Question 68

antiradial

Answer 68

plane of imaging on ulrasound of the breast that is perpendicular to the radial plane of imaging

Question 69

asymptomatic

Answer 69

without symptoms

Question 70

breast imaging reporting and data system

Answer 70

trademark system created by the American College of Radiology (ACR) to standardize mammographic reporting terminology, categorize breast abnormalities according to the level of suspicion for malignancy, and facilitate outcome monitoring

Question 71

breast self-examination

Answer 71

part of breast cancer screening best done at the end of menses each month

Question 72

clinical breast examination

Answer 72

part of breast cancer screening done by a health care provider

Question 73

diagnostic breast imaging

Answer 73

type of breast imaging examination that is more intensive than routine screening mammography

Question 74

fremitus

Answer 74

refers to vibrations produced by phonation and felt through the chest wall during palpation

Question 75

juxtathoracic

Answer 75

near the chest wall

Question 76

hyperechoic

Answer 76

echo texture that is more echogenic than the surrounding tissue

Question 77

palpable

Answer 77

can be felt on clinical examination

Question 78

isoechoic

Answer 78

echotexture that resembles the surrounding tissue

Question 79

radial

Answer 79

plane of imaging on ultrasound of the breast

Question 80

sentinel node

Answer 80

represents the first lymkph node along the axillary node chain

Question 81

spiculation

Answer 81

finger-like extension of a malignant tumor

Question 82

nonpalpable

Answer 82

cannot be felt on clinical examination

Question 83

anechoic

Answer 83

without echoes

Question 84

hypoechoic

Answer 84

having relatively weak echoes

Question 85

cyst aspiration

Answer 85

common diagnostic and interventional procedure that involves placing a needle through the skin of the breast into a cystic mass and pulling fluid out of the cyst through the needle

Question 86

breast cancer screening

Answer 86

preventive care that includes annual screening mammography (starting at age 40), monthly breast self-examination, and regular clinical breast examination

Question 87

adenosis

Answer 87

overgrowth of the stromal and epithelial elements of the acini within terminal ductal lobular unit (TDLU) of the breast

Question 88

apocrine metaplasia

Answer 88

form of fibrocystic change in which the epithelial cells of the acini undergo alteration

Question 89

atypical ductal hyperplasia

Answer 89

the pathologist recognizes some, but not all, of the features of ductal carcinoma in situ

Question 90

atypical hyperplasia

Answer 90

abnormal proliferation of cells with atypical features involving the TDLU, with an increased likelihood of evolving into breast cancer

Question 91

atypical lobular hyperplasia

Answer 91

shows, some, but not all, of the features of lobular carcinoma in situ

Question 92

cyst

Answer 92

fluid-filled sac of varible size

Question 93

epithelial hyperplasia

Answer 93

proliferation (hyperplasia) of epithelial cells lining the terminal duct-lobular unit

Question 94

fibroadenoma

Answer 94

most common benign solid tumor of the breast, consisting primariy of fibrous and epithelial tissue elements

Question 95

fibrocystic condition

Answer 95

condition that represents different, essentially normal, tissue processes within the breast that in some patients become exaggerated to the point of raising concern for breast cancer

Question 96

Paget's disease

Answer 96

surface erosion of the nipple characterized by redness with flaking and crusting caused by direct invasion of the skin of the nipple by underlying breast cancer

Question 97

peau d' orange

Answer 97

descriptive term for skin thickening of a breast that resembles the skin of an orange

Question 98

infiltrating ductal carcinoma

Answer 98

cancer of the ductal epithelium; most common general category of breast cancer, accounting fro approximately 85% of all breast cancers

Question 99

infiltrating lobular carcinoma

Answer 99

cancer of the lobular epithelium of the breast, arises at the level of the TDLU

Question 100

isoechoic

Answer 100

echo texture that resembles the surrounding tissue

Question 101

lobular carcinoma in situ

Answer 101

neither considered a true cancer nor treated as such

Question 102

lobular neoplasia

Answer 102

term preferred by many authors to replace LCIS and atypical hyperplasia

Question 103

multicentric breast cancer

Answer 103

breast cancer occurring in different quadrants of the breast at least 5 cm apart

Question 104

multifocal breast cancer

Answer 104

breast cancer occurring in more than one site within the same quadrant of the same ductal system of the breast

Question 105

breast cancer

Answer 105

involves two main types of cells (ductal and lobular)

Question 106

gynecomastia

Answer 106

hypertrophy of residual ductal elements that persist behiing the nipple in the male