Benign Breast Lesions Flashcards
What causes a simple cyst in the breast?
Obstruction of extralobular terminal duct by fibrosis and intraductal epithelial proliferation, accumulation of secretions causes duct dilatation and cyst forms
Where do simple cysts in the breast arise from?
TDLU
What is the MC cause of a breast lump?
simple cyst
When are simple cysts in the breast MC?
35-50, can persist after menopause with HRT
What does a simple cyst look like on mammogram?
- round/oval
- water density mass
- thin halo
- calcification = eggshell appearance
- no architectural distortion
What are complicated cysts related to?
fibrocystic changes or benign epithelial proliferative disorders
What are possible components of a complicated cyst?
- protein globules
- cellular debris
- cholesterol crystals
- blood
- purulent material
- milk of calcium
What are some US features of a complicated cyst?
- thin septations
- fat-fluid levels
- fluid-debris levels
- wall thickening
- cluster of microcysts
What are differential diagnoses of a complicated cyst?
- complex cyst
- hemorrhagic cyst or hematoma
- infected cyst/abscess
- galactocele
- sebaceous cyst
- oil cyst
What is a complex cyst?
mixed cyst/solid, related to fibrocystic change or epithelial proliferative disease
What are differential diagnoses of a complex cyst?
- complicated cyst
- papillary apocrine metaplasia
- papilloma
- necrotic tumor
- colloid carcinoma
What is colloid carcinoma AKA?
mucinous carcinoma
What is a sebaceous cyst AKA?
epidermal inclusion cyst
How does a sebaceous cyst form?
- from dermal layer of skin
- obstruction of sebaceous gland or hair follicle
- also from trauma
What does a sebaceous cyst contain?
oil, sebum or keratin
What are the clinical signs of a sebaceous cyst?
- palpable, subcutaneous mass
- bulge in skin
- darkened pore
- inflamed/tender
- can rupture & cause abscess
Where do sebaceous cysts usually form on the breast?
IMF, medial edge, axilla, nipple
What are US features of a sebaceous cyst?
- focal skin thickening
- low-medium echoes
- wall calcs
- possible skin tract
What is a galactocele?
milk filled cyst appearing during or shortly after lactation period
What causes a galactocele?
obstruction of lactiferous duct or peripheral TDLU
What can happen due to infected galactocele? What can happen to a noninfected galactocele?
mastitis or abscess, can also transform into oil cyst (non infected)
Where are galactoceles typically located?
retroareolar
What are US features of a galactocele?
- multiloculated
- fluid-fat levels
- aspiration: milky fluid
What are mamm features of a galactocele?
- variable density depending on fat content
- usually radiolucent
- rim calcs possible
What is the MC diffuse breast disorder?
fibrocystic disease
What is fibrocystic disease?
- proliferative and involutional changes
- causes variety of stromal and glandular alterations
- can occur from exaggerated hormone response
What tissue changes can occur due to fibrocystic disease?
- stromal fibrosis
- adenosis
- epithelial hyperplasia
- cysts
Who does fibrocystic disease occur in most commonly?
35-55 yo
What are clinical signs of fibrocystic disease?
- cyclic breast pain or tenderness
- diffuse circumscribed firmness or nodularity
- nipple discharge
- regress after menopause
What differentiates macro vs micro cysts?
macro >2 mm, micro <2 mm
What is the US appearance of fibrocystic disease?
- cyst clusters
- ductal changes ex. subareolar duct ectasia, thickening
- hyperechoic parenchyma
- fibrosis: shadowing
What is PASH?
pseudo angiomatous stromal hyperplasia, form of fibrocystic disease, precancerous, incidental biopsy finding
What does PASH look like on US?
well-defined, irregular hypoechoic mass, discrete region of tissue
What are differential diagnoses for PASH?
- fibroadenoma
- fibroglandular tissue
- spiculated mass
What is the MC benign, solid breast mass?
fibroadenoma
What is a fibroadenoma made of?
- connective & epithelial tissues
- estrogen induced
When are fibroadenomas MC?
15-35 (repro age), MC breast tumor under 30
What happens to fibroadenomas with age?
- hyalinization
- degeneration
- sclerosis
- necrosis
- calcification
What happens to fibroadenomas during pregnancy?
rapid growth
What are the clinical signs of fibroadenoma?
- discrete, firm, rubbery
- non-tender, palpable mass
- mobile
- <3 cm
Who are fibroadenomas more common in?
African American women
What are US features of a fibroadenoma?
- solid
- well circumscribed
- thin, echogenic pseudocapsule
- hypo/isoechoic to fat
- thin refractive edge shadowing
- smaller: homo, larger: hetero
What is the appearance of a fibroadenoma on mammo?
- low density, radiopaque
- lobulated contour, distinctive notch
- thin, radiolucent halo
- degeneration = coarse, popcorn or eggshell calcification
What is intraductal papilloma?
- focal epithelial proliferation within a duct
- usually small, can grow to several cm
Where are intraductal papillomas MC?
subareolar within major lactiferous duct
What is papillomatosis?
multiple peripheral papillomas, smaller from TDLU, higher risk for malignancy
What are clinical signs of intraductal papilloma?
- persistent blood or serous nipple discharge
- too small to palpate
What ages are intraductal papillomas MC in?
30-55
What is the MC cause of bloody nipple discharge?
intraductal papilloma
What are US features of a intraductal papilloma?
- sub/periareolar
- can be seen with dilated fluid-filled duct
- round, oval, tubular
- hypo/iso to fat
- dilation of single duct may indicate tiny papilloma
What imaging technique can be used to document the number and location of intraductal papillomas?
contrast ductography (mamm)
What is intracystic papilloma?
papilloma growing from fibrovascular stalk within lumen of serous or hemorrhagic cyst
How can a cyst be formed by a papilloma?
Duct is blocked by growing soft tissue tumor
What is associated with large intracystic papillomas?
hemorrhagic or malignant change
How does an intracystic papilloma appear on US?
- cystic/solid
- mural nodule or focal wall thickening
- nodule: medium echoes, homo, smooth lobulated contour
What is a lipoma?
nodule of mature adipose tissue encased by thin connective tissue capsule
Where are lipomas usually found in the breast?
superficial fat layer but can be anywhere, hard to distinguish from fatty tissue
What can an axillary lipoma be mistaken for?
lymph nodes
What causes calcification of a lipoma?
internal fat necrosis
What is a hamartoma?
uncommon intraglandular mass, proliferation of fibrous, glandular and fatty tissues encased by thin layer of connective tissue
What is a hamartoma AKA?
fibroadenolipoma, adenofibrolipoma
What are clinical signs of a hamartoma?
- asymptomatic
- usually >3 cm
- soft/firm, movable
Where are hamartomas MC?
UOQ, subareolar
Who are hamartomas MC in?
early 40s
What does hamartoma look like on US?
- thinly encapsulated
- oval, lobulated
- heterogenous
- shadowing dependent on amount of fibrous tissue
- moderately compressible
What does hamartoma look like on mamm?
- encapsulated island of mixed densities
- breast within a breast appearance
What are different types of mastitis?
- puerperal
- nonpuerperal
- infected cyst
- inverted nipple with SA abscess
- plasma cell
- nonspecific
- granulomatous
- foreign body
- certain disease
- parasitic
What is the US appearance of mastitis?
- skin thickening
- increased echogenicity
- prominent lymph channels parallel to skin
- dilated ducts
- edematous parenchyma
- hypervascularity
- possible abscess formation
What is plasma cell mastitis? When does it occur?
nonpuerperal form of mastitis, occurs around menopause
What are the clinical signs of plasma cell mastitis?
- nipple discharge
- nipple retraction
- SA fullness (can mimic cancer)
- SA dilated ducts- can lead to periductal inflammation & fibrosis
What is acute lactational mastitis?
- bacteria enters breast via cracked nipple or skin wound (usually staphylococcal infection)
- carried by blood or lymph, travels through ducts
What is the MC cause of acute mastitis? How is it treated?
lactation, resolves with antibiotics
What does acute mastitis need to be differentiated from?
inflammatory ca
What are clinical symptoms of acute mastitis?
- tender, swelling
- plugged duct
- purulent discharge
- skin thickening, erythema
- enlarged painful lymph nodes
- leukocytosis & fever
Where do breast abscesses MC form and what causes them?
Usually subareolar, complication of mastitis or infected cyst
What are predisposing factors for breast abscess?
- puerperal mastitis
- infected cyst
- inverted nipple
- mammary duct fistula
- post-op infection
- cigarette smoking
What is the US appearance of abscess?
- complex fluid collection
- anechoic or mixed echo
- possibly septated
- hypervascular walls
What causes a hematoma in the breast?
- vessel damage: trauma, sx, aspiration or biopsy
- increased risk if bleeding disorder or on anticoagulants
What is a seroma? How is it treated?
- collection of serous fluid following sx
- conforms to surgical cavity
- small: reabsorbs, large: needs drainage
What are the clinical signs of a seroma?
- palp mass at sx site
- if in axilla after ALND, can lead to lymphedema
What is the sono appearance of a seroma?
- lobulated
- anechoic/hypoechoic
- complex with septations
- enhancement
What is fat necrosis and what are its two presentations?
- focal hemorrhage and liquefaction of fat leading to necrosis
- fibrotic mass or oil cyst
What causes fat necrosis?
inflammatory process or idiopathic
Who is fat necrosis MC in?
older women with fatty breasts
What does fat necrosis look like on US?
- oil cyst
- sclerotic mass
- complex, anechoic, fat-fluid level, echogenic bands or mural nodule
- increased wall echogenicity
What does fat necrosis look like on mamm?
- spiculated mass with possible central lucency
- irregular mass without calcs
- oil cyst: round, radiolucent mass with or without rim calcs
What is a radial scar?
- complex, sclerosing lesion
- assoc. with increased risk of cancer in both breasts
- diagnosed via biopsy
What are the US features of a radial scar?
- spiculated, can mimic cancer
- firm, irregular mass
- may simulate fat necrosis
- ductal hyperplasia
What are common side effects of radiation therapy?
skin thickening and fibrosis
What are US features associated with radiation treatment?
- skin & parenchymal edema
- vascular & lymphatic dilation
- fluid collections
- fat necrosis
- calcs
What causes gynecomastia?
increased estrogen and decreased testosterone causes abnormal proliferation of ductal glandular tissue and stroma
What are clinical signs of gynecomastia?
- breast enlargement
- SA thickening
- SA palp mass
What are some physiologic causes of gynecomastia development?
- idiopathic
- hormonal changes
- Klinefelter’s syndrome
- thyroid disease
- testicular failure
- neoplasms (testicular, adrenal, hepatocellular)
- systemic disease ex. cirrhosis or renal failure
What are acquired causes of gynecomastia development?
Drug induced
- estrogen treatment
- steroids
- marijuana
- antidepressants
- AIDS meds
- digitalis therapy
