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ABDOMEN 4 > 4.2 Breast Pathology > Flashcards

4.2 Breast Pathology Flashcards

1
Q

Cysts are common findings in age __ - ___

A

35-50 years

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2
Q

Breast cysts are the result of?

A

obstructed ducts

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3
Q

Breast cysts can have these features

A

palpable, rounded, some mobility, single/multiple, variable in size, can change with compression

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4
Q

What are complex cysts in the breast with low level echoes called?

A

Foam cysts

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5
Q

Complex cysts in the breast may also have these features

A

septations, debris and ALWAYS posterior enhancement

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6
Q

Cysts that display a non-dependent echogenic layer?(not mobile debris, solid tissue on cyst wall NOT MOBILE)

A

Acorn cyst

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7
Q

WHAT IS THE MOST BENIGN SOLID TUMOR OF THE BREAST

A

FIBROADENOMAS

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8
Q

Fibroadenomas form in ___ and are stimulated by____

A

adolescence; estrogen

may increase size with prego and HRT

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9
Q

Fibroadenomas appearance?

A

Variable size/shape
uni/bilateral
often appear as palpable, painless and mobile

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10
Q

Fibroadenomas Sonographic appearance?

A 
Eliptical/oval
gently lobulated
Thin echogenic capsule
Hypoechoic
Homogenous
wider than tall
solid
typically no enhancement 
no change with compression (fat lobule will demonstate this)
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11
Q

Rare finding AKA “Giant Fibroadenoma”

A

Cystosarcoma phylloides

larger and more lobulated and can have systic spaces than firadenoma

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12
Q

Are Cystosarcoma phylloides typically benign or malignant?

A

Benign but can be malignant

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13
Q

Cystosarcoma phylloides are common in ages__ to __ and _____ increase in size.

A

40-50; rapidly

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14
Q

A Benign fatty tumor in middle aged/postmenopausal patient, often asymptomatic?

A

Lipoma

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15
Q

Lipoma sonographic appearance

A

May appear as hypoechoic mass (but relative to surrounding tissue)
Defined margins

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16
Q

Hemorrhage or liquefaction of fatty area in breast that leads to necrosis?

A

Fat Necrosis

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17
Q

Fat Necrosis is often a result of ?

A

TRAUMA,(Most common, seatbelt ) surgery or inflammation

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18
Q

Fat Necrosis forms a dense ___ or ___ and the areas may ____

A

Scar or cyst (lipid cysts); calcify

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19
Q

Fat Necrosis can present with (3)

A

Firm nodule, skin retraction, nipple inversion

also seen with malignant nodules, hx important

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20
Q

Sonographic appearance Fat Necrosis?

A

poorly defined, Irregular hypoechoic, complex mass may shadow

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21
Q

Benign solid masses in lining of ducts (can develop into cysts)

A

PAPILLOMA

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22
Q

Papilloma is the most common cause of?

A

bloody nipple discharge

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23
Q

Papilloma typically located?

A

near nipple

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24
Q

Papilloma sonographically

A

Solid lesion in a duct or cyst
possible ductal ectasia (dilation) near mass
Doppler - vascular stalk or feeding artery

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25
Q

A commmon exaggerated cyclic change in breast tissue where cells proliferate and retain water?

A

FIBROCYSTIC CHANGE

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26
Q

Fibrocystic change is typically in this location?

A

UOQ

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27
Q

Fibrocystic S & S

A

Lumpy, swollen, painful breasts, nodulatity
nipple discharge
mammographic changes

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28
Q

Fibrocystic Sonographically?

A

multiple cysts, echogenic tissue and small nodules

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29
Q

A milky cyst from an obstructed lactiferous duct

seen in prego or lactating

A

GALACTOCELE

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30
Q

Most galactocele are located in the ___ region and can lead to___

A

retroareolar; mastitis (inflammation of the breast)

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31
Q

galactocele Sonographiclly

A

Well definded cystic mass with internal debris

less posterior enhancement then in simple cyst

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32
Q

Dilated Ducts in the breast are called?

A

DUCT ECTASIA

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33
Q

Duct Ectasia appear sonographically as?

A

tubular hypoechoic structures converging toward the nipple (>8mm)

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34
Q

Duct Ectasia are seen in ___ patients or pt >__ years of age. Usually ______ but can lead to ____

A

lactating ; >50 years;

asymptomatic; mastitis

35
Q

mastitis is the inflammation of the breast. common during lactation. Is more commonly focal or diffuse?

A

FOCAL

36
Q

Mastitis obstruction can lead to ___ ___ and can form an____

A

bacterial infection; abscess

37
Q

S+S of mastitis include

A 
Hot, red, tender breast, fever, 
palpable mass (focal form), nipple discharge
38
Q

Acute mastitis (inflammation/infection) sonographically?

A

Irregular fluid collection with debris
loss of tissue definition with edema
complex, shaggy wall
septations, posterior enhancement

39
Q

Nipple discharge that is low risk appears?(benign)

A

bilateral
involving multiple duct orifices
milky or greenish
fibrocystic change or duct ectasia

40
Q

Nipple discharge that is high risk appears?

A

unilateral
spontaneous (no pressure is needed)
clear, bloody or serous (clear yellow fluid)
maybe a glactogram procedure ( filling defects )

41
Q

Malignant lesions get characterized by 2 things

A

Location
and
invasiveness

42
Q

MOST MALIGNANCY IS LOCATED IN WHAT LOCATION?

A

UOQ

43
Q

Malignant Characteristics include (LONG LIST)

A
  • Hypoechoic (VERY compared to surrounding)
  • Taller than Wider
  • Angled margins/spiculations (spike, lesions have tiny little jagged spikes protruding from them)
  • Heterogenous
  • Posterior shadowing
  • Thick echogenic rim (thicker and more irrgeular than capsule) or halo
  • Ductal extension/branching
  • Microlobulations (tiny and more of them)
  • Calcifications
44
Q

Secondary findings of malignancy include:

A
  • Skin changes (thickening, flattening retraction)
  • Inverted nipple
  • Axiallary or intramammary lymph nodes
  • Dilated ducts
  • Highly echogenic surrounding tissue
  • Thickened coopers ligaments
45
Q

What are the 2 types of breast Carcinomas?

A

Non invasive and Infiltrating (invasive)

46
Q

What are the 3 types of Non invasive?

A

DCIS (ductal carcinoma in situ)
Lobular carcinoma in situ
Intracystic papillary carcinoma in situ

47
Q

What are the 3 types of Invasive/infiltrating?

spread outside of duct or lobular they originate in.

A

Infiltrating ductal
Infiltrating lobular
Others

48
Q

What does in situ mean?

A

still in the duct. Not invaded outside of the structure

49
Q

THE MOST COMMON NONINVASIVE MALIGNANT TUMOR

NOT THE MOST COMMON MALIGNANCY

A

DCIS (ductal carcinoma in situ)

50
Q

DCIS common in postmenopausal and presents with nipple discharge and has what in 80% of the masses?

A

Microcalcificaitons*

51
Q

Lobular carcinoma in situ has an increased incidence in the ____ years and is not a ____ cancer (more a marker)

A

reproductive; true

52
Q

Intracystic papillary carcinoma in situ is ___ and more common in middle aged females. It is ___ ___and is a __mass

A

RARE; well defined; mobile

solid.

53
Q

INVASIVE

MOST COMMON TYPE OF BREAST CANCER IS?

A

Invasive ductal carcinoma

65%

54
Q

Invasive ductal carcinoma present as? and are located?

A

Hard stationary, painless, palpable mass ; UOQ

55
Q

Sonographically Invasive ductal carcinoma have(2)

A

Microcacs and spiculations

56
Q

Less common invasive carcinoma is

A

Invasive lobular carcinoma. 8-13%

57
Q

THE MOST FREQUENTLY MISSED CANCER?

A

Invasive lobular carcinoma

difficult to detect on both mammo + US

58
Q

Invasive lobular carcinoma often has development of a second primary in opposite breast and presents with ___ ___

A

Nipple retraction

59
Q

Other types of invasive carcinoma include?

A

medullary
Mucinous
Papillary

60
Q

Medullary are rare ____ growing, ___ aged, looks like fibroadenoma (need biopsy)

A

fast; middle

61
Q

Mucinous are rare, __ growing in ___ women

A

slow;older

62
Q

Papillary are in ____women, bloody nipple discharge, central breast area and they have a ____prognosis

A

postmenopausal; good

63
Q

PRACTICE

Anechoic, oval, distinct backwall, posterior enhancement, single tiny septataion

A

Complex Cyst with one thin septation

64
Q

Solid mass, homogenous, hypoechoic, oval, well defined, smooth wall, thin echogenic capsule

A

Fibradenoma

65
Q

Poorly defined, very hypoechoic, few bright echogenic foci (microcalcs), shadowing, thick echogenic rim

A

Malignant
(most common ductal cell carcinoma)
also microcalcs. need biopsy to confirm.

66
Q

Augmented Breast can be __ or ___ and be placed anterior or posterior to the ___ ___

A

silicone or saline; pectoralis muscle

67
Q

What is the concern with breast implants

A

rupture and

contracture of the capsule, disforming breast and implant

68
Q

Sonographically

A

echo free oval, posterior to breast tissue (looks like big cysts

69
Q

What is the artifact associated with breast implant?

A

anterior reverb artifact

most anterior less bright wall is the capsule, body walled it off, other 2 implant shell itself

70
Q

2 features of normal implant to be aware of?

A

Radial folds

and Fill valves

71
Q

Radial folds are ___ folds that is seen when patient is in ____ position. (normal)

A

anterior; supine

72
Q

Fill valves seen with ___ implants, typically located directly located ___ to nipple and are ____

A

Saline, posterior; palpable

73
Q

2 types of silicone leak (rupture)

A

Intra-capsular

Extra-capsular

74
Q

Intra-capsular tear is?

A

Tear in shell

gel trapped between capsule (formed by body) and implant shell.

75
Q

Sonographically the Intra-capsular appears as the what sign?

A

“stepladder sign”

numerous linear echogenic structures in implant

76
Q

Extra-capsular tear is?

A

Tear through shell and capsule formed by body

silcone leaking into body tissues

77
Q

Sonographically the Extra-capsular appears as the what sign?

A

“Snowstorm sign”

a lot of echogenic noise

78
Q

Silicone bleeds occur in all silcone implants they are microscopic leaks, through an intact shell that are contained in fibrous capsule. Migrates to the lymph nodes resulting in?

A

results in lymphadenopathy

79
Q

Contracture of silcone. Normal response is a fibrous capsule forming around implant. The capsule should be _____ than the implant and flexible. With contracture the capsule contracts and _____the breast

A

larger; Disfigures

80
Q

What is male breast enlargement called?

A

Gynecomastia

81
Q

What causes Gynecomastia

A

abnormal proliferation of glandular tissue and increased subcutanous fat.

82
Q

what is Gynecomastia linked to? (3)

A

Estrogen and androgen use
drugs for hypertension and depression
estrogenic neoplasms

link to breast cancer unclear

83
Q

S & S Gynecomastia

A

Enlarged breast
palpable firm mass under nipple
tenderness

84
Q

Sonographically Gynecomastia

A

Triangular region of hypoechoic glandular tissue under areolar region
ducts converging towards nipple
can be increased fat

ABDOMEN 4 (10 decks)

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