2015 OSU Breast

Question 1

Elderly female with spiculated mass. What is most likely dx?

Answer 1

Invasive Ductal Ca (65-86% of all breast Ca)

• Genetics: ~90% sporadic, ~10% genetic (BRCA)
• All breast carcinomas arise from terminal ductal lobular unit (TDLU)
• T2WI FS: usually hypointense focal mass if visible
• T1WI C+ FS: ~90% of IDC NOS enhances rapidly and intensely.

*Lobular carcinoma also most commonly presents as a mass.

Question 2

Papillary Cancer

Answer 2

Large intraductal mass is common.
Ductal dilation

Discussion: Improved outcome for papillary carcinoma as compared to invasive ductal carcimoma, second most common invasive cancer.

• Noninvasive papillary carcinoma = Papillary DCIS
• Intracystic papillary carcinoma is papillary DCIS within a dilated duct.
• Invasive carcinoma, STromal invasion is present:
  
  • Mostly circumscribed complex cystic and solid mass in an elderly pt.
  • Galactographic findings-ductal obstruction, wall irregularity, filling defects
  • Nipple discharge in ip to one third of cases.

Question 3

Technical question about MR breast concerning “3D, special program name, SNR”

Answer 3

???

Question 4

MR enhancement patterns of normal tissue and some benign disease:

Answer 4

Rapid rise and washout (type III, 6% benign/94% malig)

• No enhancement (radial scar, DCIS, small invasive carcinoma)
• SLow rise and persistent delayed enhancement (type I, 83% benign)
• Plateau (early initial enhancement, type II)

Question 5

LEsion with layering echogenicity:

Answer 5

Galactocele

Question 6

8x increased risk of developing cancer?

• Atypical ductal hyperplasia
• Atypical lobular hyperlasia
• LCIS
• Proliferation without atypia

Answer 6

• Atypical ductal hyperlasia (2-3x increased risk)
• Atypical lobular hyperlasia (2-3x increased risk)
• LCIS -CORRECT ANSWER (7-11x increased risk)
• Proliferation without atypia (1.5-2x increase)

Question 7

Microcalcs with stereotactic biopsy and get a false negative, likely due to what?

• More specimens needed
• More experienced radiologist
• Sampling error

Answer 7

Sampling error (sampled inappropriate site)

Question 8

MLO vs ML view

Answer 8

More inferior breast tissue in ML view

Discussion:

• Advantages of ML view: lose VOR, orthogonal, central/lateral lesions, LM good for medial, less tissue/pectoral
• MLO: more tissue, more difficult localization

Question 9

Fat necrosis Most common cause:

Answer 9

Trauma and surgery