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