Benign & Malignant Characteristics Flashcards
What are clinical symptoms of a benign mass?
- soft, rubbery
- mobile
- tender/painful
- redness with fever and pain
- nipple discharge that is green or white
What are clinical symptoms of a malignant mass?
- firm, non mobile
- asymptomatic
- focal redness
- skin dimpling
- retracted nipple
- clear or bloody nipple discharge
- enlarged lymph nodes
What are indications that nipple discharge is benign?
- comes out when expressed
- bilateral
- green: infection
- white/milky: benign ductal tumor or blockage, hormonal response
What are indications that nipple discharge is malignant?
- spontaneous
- unilateral
- blood: cancer cells invading ductal tissue
- clear: abnormal proliferation of ductal epithelial cells
How can benign vs malignant nipple retraction be differentiated?
Benign: bilateral, life-long, intermittent
Malignant: spontaneous, does not extrovert, unilateral
What are some typical benign mass shapes and orientations?
- round, oval
- macrolobulations
- horizontal (long axis parallel to chest wall and skin)
- wider than tall
What are some malignant mass shapes and orientations?
- irregular shape
- vertical orientation (long axis perpendicular to chest wall)
- taller than wide
How does the echogenicity of benign findings compare to that of malignant findings?
benign:
- uniformly hyperechoic = benign fibrous tissue
- low to medium internal echoes or anechoic
malignant:
- hypoechoic
- some can be mildly hyperechoic or isoechoic to fat
Are benign and malignant masses typically homo or heterogenous?
benign: homogenous, larger masses can be heterogenous due to fibrosis, degen, calcification
malignant: heterogenous, highly cellular ca can be homogenous
What is the difference in posterior changes of benign and malignant masses?
benign: enhancement, minimal/no enhancement, some can shadow
malignant: shadowing, architectural distortion, obscured posterior wall, many display enhancement
What is the difference between benign and malignant mass margins?
benign: defined, circumscribed, abrupt transition b/w mass & tissue
malignant: ill-defined, non circumscribed, indistinct margins into surrounding tissue
Describe the characteristics of borders for benign and malignant findings.
benign: smooth, mild macrolobulation (< 3)
malignant: spiculated, angular, microlobulation, intraductal tumor extension
What does a spiculated mass look like?
- alternating hyper & hypo lines radiating from surface of mass
- possible echogenic halo
What are angular borders?
- irregular jagged margins
- specific for malignancy
- occurs where resistance to invasion is lowest
What is the border thickness/echogenicity of a benign mass typically like?
thin, echogenic pseudocapsule, compresses adjacent tissues
What is the border thickness/echogenicity of a malignant mass commonly like?
- thick, echogenic halo = tumor infiltrations
- peritumoral lymphedema can increase surrounding echogenicity
- posterior features obscured by shadowing
- hyperechoic rim
How do you know which direction intraductal tumor extensions are going?
- projections from a mass that extends within a duct: toward the nipple
- projections branching outward: tumor extending away from nipple
What are benign ductal changes and what causes them?
- ductal ectasia (dilation): pregnancy, lactation, mastitis, menopause, fibrocystic changes, distention from benign mass
- ductal echoes: proliferative changes, papilloma, fluid
What are malignant ductal changes?
localized duct dilatation, irregularity, thickening, nodularity, microcalcs, bloody nipple discharge: intraductal cancer
When can microcalcs be visualized on US?
in a hypoechoic mass
What are the common appearances of benign calcifications?
- coarse
- large
- shadowing
- popcorn look of old fibroadenomas
What can cause formation of benign calcifications?
necrosis, hemorrhage, scar
What can cause curvilinear rim calcifications?
complication of sebaceous cysts, oil and hemorraghic cysts
What does a milk of calcium cyst look like?
tea cup appearance on mamm
