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Benign Lesions Flashcards

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1
Q

Most common cause of bloody nipple discharge

A

Papillomas

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2
Q

What’s a trigger point?

A

The compression over a papilloma which elicits the discharge

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3
Q

What is necessary in patient’s with papilloma’s, as a mammogram usually appears normal?

A

Ductogram

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4
Q

Sono appearance of a papilloma?

A

Homogenous, hypoechoic and connected to a vascular stalk

Usually not palpable

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5
Q

Solitary papillomas arise from the _____ whereas multiple peripheral papillomas originate from within the _____.

A

duct, TDLU

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6
Q

Swiss cheese appearance

A

Juvenile Papillomatosis

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7
Q

Sono appearance of juvenille papillomatosis ?

A

Well circumscribed, heterogenous w one or several small cystic areas seen near the borders of the lesion.

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8
Q

Juvenille papilloma’s are large tumors, typically around 4cm in size.

A

True

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9
Q

Most common benign soft tissue mass of the breast?

A

Lipoma

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10
Q

FA’s and lipomas can look very similar. How can we tell the difference?

A

Lipoma’s are far more compressible than fibroadenoma’s. (30%)

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11
Q

Sono appearance of Phyllodes tumors

A

Rapidly enlarging. Well circumscribed, hypoechoic oval mass. Decreased through transmission. Can see cystic spaces.

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12
Q

Difference between Phyllodes tumor and lactating adenoma?

A

Lactating adenoma will be seen in patients who are pregnant or nursing.

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13
Q

Sono appearance of lactating adenoma:

A

A large, oval, well-defined, mobile, macrolobulated mass w echogenic bands within. Also demonstrate posterior acoustic enhancement

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14
Q

How do we differentiate fibroadenoma’s from tubular adenoma’s?

A

They appear similar, however TA’s will have tightly packed punctate calcifications within.

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15
Q

Sono appearance of tubular adenomas:

A

Mobile. Homogenous, hypoechoic, well circumscribed margins and little through enhancement.

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16
Q

What is described as a “breast within a breast” on mammo?

A

Hamartoma (fibroadenolipoma or adenofibrolipoma)

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17
Q

Sono appearance of a hamartoma:

A

Appearance varies based on composition ( fibrous vs fatty tissue). May exhibit a mixed echotexture w hyperechoic tissue surround hypoechoic areas.

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18
Q

Breast inflammation and/or infection occurs most frequently during:

A

Lactation

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19
Q

Acute mastitis is usually widespread across the entire breast for a short period of time.

A

False – it is confined to one area of the breast. Only if the infection is carried by the lymphatics or blood vessels can it spread throughout the breast.

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20
Q

What typically causes acute postpartum mastitis ?

A

Bacterial invasion through an irritated nipple and is precipated by milk stasis. Occurs around 2wks PP.

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21
Q

Most common bacterial cause of acute postpartum mastitis?

A

Staphyoloccocus aureus, originating from the nursing child.

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22
Q

Chronic mastitis is the inflammation of glandular tissue and is usually seen in?

A

Elderly women

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23
Q

Chronic mastitis clinical symptoms?

A

Nipple discharge and retraction

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24
Q

Ultrasound examination of those with mastitis appears as:

A

Normal, or
skin thickening/edema, altered tissue echogenicity, increased volume of tissue, ductal ectasia or dilation of lymph vessels parallel to the skin

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25
Q

Most common form of mastitis?

A

Occurs in the puerpheral period (<6wks after birth) during lactation. Caused by an obstruction of a lactiferous duct

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26
Q

Mastitis can lead to a(n):

A

abscess

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27
Q

Ballottement:

A

A technique for palpating an organ or floating structure by bouncing it gently and feeling it rebound. A “color swoosh” is shown as the necrotic tissue moves back and forth with compression and compression release.

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28
Q

Difference between periductal mastitis and duct ectasia:

A

Periductal mastitis: NON dilated subareolar ducts that become infected. Affect younger women.
Duct Ectasia: dilated subareolar ducts that are less likely to become infected. Affect older women.

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29
Q

What condition can we see a spontaneous drainage from the mass or nipple?

A

Abscess

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30
Q

A patient w a history of smoking, has spontaneous drainage, nipple inversion, fever, red skin and warm skin. What is likely happening?

A

Abscess

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31
Q

Chronic vs acute abscess:

A

Chronic: More defined, central fluid collection w posterior enhancement
Acute: irregular borders, thick walls and a central fluid collection w free air within the mass

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32
Q

The most common type of closed or blunt trauma is?

A

contusion – hematoma or bruise. Ex. seatbelt injury

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33
Q

Fat necrosis is most common in

A

Obese women with large breasts

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34
Q

What is most common in the end stage of fat necrosis?

A

Oil cysts

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35
Q

What does fat necrosis appear as?

A

A firm, shadowing, irregular mass that may mimic carcinoma. Can be associated with skin retraction and architectural distortion.

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36
Q

What diagnoses oil cysts (fat necrosis)?

A

FNA

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37
Q

Fat necrosis changes to what appearance over a period of time?

A

Partially or totally calcified

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38
Q

What’s the most common post surgical complication?

A

Seroma (50-60%)

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39
Q

A patient underwent a lumpectomy for breast cancer. Upon US eval, an oval, well circumscribed, thick walled, complex, cystic mass w fat locules and septations was found near the scar. What is this?

A

Seroma

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40
Q

What’s a common complication following radiation?

A

skin thickening (up to 2 yrs after)

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41
Q

Skin thickening is defined by which measurement?

A

2mm

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42
Q

Radial scars are not related to previous trauma or surgery.

A

True– they are actually benign.

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43
Q

Radial scars have what appearance on mammo? They are hard to identify on which view?

A

They appear as a spiculated lesion w or w/o calcification. They appear stellate with a central lucent core. Hard to identify in an orthogonal view

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44
Q

Are radial scars palpable?

A

No

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45
Q

Are radial scars malignant?

A

No, but may be a precursor to carcinoma, especially if they’re >2cm.

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46
Q

Mondor’s Disease:

A

Thrombophlebitis of the subcutaneous veins of the breast.

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47
Q

Which veins are most common affected with Mondor’s disease?

A

Lateral thoracic and thoraco-epigastric veins

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48
Q

What is the sonographic and mammographic appearance of Mondor’s disease?

A

Sono - tubular, hypoechoic structure (thrombosed vein)

Mammo- beaded, subcutaneous vein w skin retraction and rarely vein calcification.

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49
Q

A patient presents with tenderness, and pain on the right breast. Upon physical examination, skin retraction is noted over a cord-like structure extending on the chest wall. What is this?

A

Mondor’s disease

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50
Q

What is commonly seen in women w long term type 1 diabetes?

A

Diabetic fibrous mastopathy

51
Q

Sono appearance of diabetic fibrous mastopathy

A

Single or multiple, firm-to-hard breast lumps, ill-defined, non-tender, shadowing, hypoechoic, attenuating, easily moveable and without fixation to the skin

Biopsy is performed to differentiate from cancer

52
Q

What’s adenosis?

A

proliferation of the ducts and lobules

53
Q

What’s epitheliosis?

A

hyperplasia of the epithelial cells within the ducts or lobules

54
Q

What’s fibrosis?

A

proliferation of stromal tissue

55
Q

What’s the etiology of a radial scar?

A

Unknown

56
Q

What does BIRADS stand for

A

Breast imaging reporting and data system

57
Q

What’s the most common palpable pseudomass?

A

Fibrous ridge

58
Q

Fibrous ridges usually demonstrate ______________ when compared to surrounding fat?

A

pure echogenicity

59
Q

Large lesions are more likely to be malignant.

A

false - size is not a good indicator of malignancy

60
Q

The prescence of what malignant characteristic has the greatest individual sensitivity and overall accuracy of any of the features?

A

Angular margins

61
Q

Spiculated margins area more common for ________ grade cancers where as angular margins are more common for ____ grade

A

low ; high

62
Q

In order to evaluate the borders of a lesion, what’s a technique we could use ?

A

Heel toe

63
Q

What’s the reason that a malignant mass is hard and has no mobility?

A

Fibroelastic host response or reactive fibrosis

64
Q

Desmoplastic reaction:

A

The body’s attempt to “wall off” a cancer, with the formation of fibrois connective tissue in order to limit invasion. Thought to be responsible for the shadow seen on high resolution imaging

65
Q

What may a echogenic rim of variable thickness represent?

A

tumor extension, desmoplasia or slightly compressed breast tissue

66
Q

Shadowing is more common with _____ grade cancers

A

low

67
Q

Enhancement is more common with _____ grade cancers

A

high

68
Q

If calcifications are diffusely scattered, they are favoured to be

A

benign

69
Q

Calcifications that are segmentally distributed or linearly distributed are

A

suspicious for DCIS

70
Q

Clustered calcifications may either be benign or malignant and are considered to be of

A

immediate concern

71
Q

Vascular and skin calcifications are

A

benign

72
Q

Popcorn calcifications, moc, plasma cell mastitis, eggshell, suture and dystrophic are

A

benign

73
Q

Fine linear, fine linear branching and fine pleomorphic calcifications are

A

suspicious for malignancy

74
Q

Amorphous and coarse heterogenous are

A

of immediate concern

75
Q

If calcifications remain stable, the risk of malignancy

A

is low

76
Q

Malignant vascular characteristics

A 
multiple vessels
25% vessels related to tumor volume
5 or more intratumoral vessels
numerous peripheral vessels
multiple tortuous vessels
multiple shunts
77
Q

Benign masses tend to remain in a

A

single tissue plane

78
Q

Duct extension

A

tumor extension into a single duct, towards the nipple

79
Q

Branch pattern

A

tumor extension into the smaller ducts leading away from the nipple

80
Q

Peau d’Orange

A

Orange skin. Describes the appearance of the breast when there is an underlying cancer, typically IBC

81
Q

The presence of multiple, identical lesions _________ the risk of malignancy

A

reduces

82
Q

What is the most common lesion of the breast?

A

Fibrocystic breast changes (50%)

83
Q

What age range do we typically see FBC?

A

20-50

84
Q

Simple cysts are relatively uncommon before the age of

A

30

85
Q

What is the age range for cysts?

A

34-55

86
Q

Cysts must be at least ________ before they can be reliably detected with US?

A

3mm

87
Q

What characteristics do simple cysts show:

A

anechoic
smooth borders
enhancement

88
Q

A complex cyst does not demonstrate: (4)

A

echo free
round/oval shape
smooth contour w well defined borders
enhancement

89
Q

What may be the reason that a cyst is complex?

A

infection
hemorrhage
wall calcification
or intramural tumor

90
Q

Acorn cyst

A

fluid-fluid level

91
Q

Galactocele appears:

A

ranges from anechoic to solid

92
Q

What is a defining characteristic of a galactocele:

A

PAE

also lactating woman

93
Q

What confirms the diagnosis of a galactocele:

A

aspiration of a thick, milky fluid

94
Q

Where do sebaceous cysts most often occur?

A

axilla, intramammary fold or medial portion of the breast

95
Q

Complex cyst that derives its name from the mobility of the highly reflective echoes contained within:

A

Gurgling cyst

96
Q

Is apocrine metaplasia benign or malignant

A

benign

97
Q

What age range do we most often see aprocrine metaplasia?

A

40-50 yrs old

98
Q

Aprocine metaplasia appearance:

A

lobulated mass composed of clusters of small, 2-5mm dilated acini w septations and partial acoustic enhancement

99
Q

Aprocrine metaplasia does not increase the risk of breast cancer, however:

A

it occurs most commonly in breasts w cancer

100
Q

What makes up approximately 50% of all benign breast pathologies?

A

FA’s

101
Q

What is the most common solid breast mass found in females under the age of 35?

A

FA’s

102
Q

Most common age range for FA’s?

A

15-35yrs, but are also found in older women undergoing HRT

103
Q

How big are giant fibroadenomas?

A

can reach up to 10-15 cm in size

although most are about 2-4cm

104
Q

What masses can calcify and exhibit a popcorn-like pattern?

A

FA’s

105
Q

The long axis of a FA is usually

A

parallel to the skin surface

106
Q

Approximately _____% of FA’s have a complex appearance

A

33

107
Q

If a FA is larger than ______ it should be biopsied

A

4cm

We also follow them looking for changes

108
Q

A 15yr old girl presents with a very large mass, which stretches the overlying skin and displaces the nipple. She also has dilated veins. What is this likely to be?

A

Juvenile FA

109
Q

What’s the most common breast sarcoma?

A

Phyllodes tumor

110
Q

Age range of Phyllodes tumors

A

mean age 45yrs

111
Q

Where are papillomas most often located?

A

SA

112
Q

Up to 50% of patients w _______________ have a 1st degree relative w a history of breast cancer

A

Juvenile papillomatosis

113
Q

How to juvenile papillomatosis tumors present?

A

painless, solitary, unilateral masses that arise from the milk duct
Large tumors
Nipple discharge
Well circumscribed heterogenous w cystic areas

114
Q

Are lipomas typically unilateral or bilateral

A

Unilateral

115
Q

Are hamartoma’s slow or fast growing

A

Slow

116
Q

How does a hamartoma feel on clinical examination?

A

mobile and compressible

117
Q

What is a hamartoma composed of?

A

fatty and fibrous tissue, as well as normal and dysplastic mammary tissue

118
Q

What are typical findings of mastitis?

A

decreased echogenicity, increased volume of tissue and mild ductal ectasia

119
Q

Where are breast abscesses most commonly found?

A

areolar or periareolar region

can be associated w lymphadenopathy or nipple inversion

120
Q

What is a common type of edema

A

premenstrual

121
Q

Cancer recurrence is suspected if the size of the breast scar:

A

increases after 2 stable clinical examinations

122
Q

People who have underwent radiation therapy can have skin thickening up to _______ following treatment

A

2 years

123
Q

Causes of skin thickening?

A 
carcinoma
trauma
inflammation
venous obstruction
lymphatic obstruction
CHF
nephrotic syndrome
124
Q

Radial scars aka

A

complex sclerosing lesions

Breast US (6 decks)

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