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RRC DDx 2 > Breast > Flashcards

Breast Flashcards

1
Q

Breast cancer types

A 
Ductal
- DCIS
- Invasive
     - No special type
     - Tubular
     - Mucinous
     - Medullary
     - Papillary
Lobular
- LCIS
- Invasive
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2
Q

High risk lesions – must be surgically excised

A 
Radial scar
ADH: Atypical ductal hyperplasia 
LCIS: Lobular carcinoma in situ 
ALH: Atypical lobular hyperplasia 
Papilloma
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3
Q

Smooth well-defined mass

A 
Cystic
- Cyst
- Seroma
- Hematoma
- Abscess
FA
Lactating adenoma
Phyllodes
PASH
High grade invasive ductal Ca 
- **Not tubular (spiculated) 
- Mucinous Ca
- Medullary Ca
- Papillary Ca
Mets
Lymphoma
Sarcoma
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4
Q

Breast lesion containing fat

A 
Lipoma / lipomatous pseudomass 
Fat necrosis
Hamartoma (fibroadenolipoma) 
Lymph node
Galactocele 
Angiolipoma
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5
Q

Cystic lesions

A 
Cyst
Hematoma
Abscess
Papillary lesion
- Encapsulated (intracystic) papillary carcinoma
- DCIS
- Invasive carcinoma
Malignancy
- Tubular adenoma
- Mucinous adenocarcinoma
- Metaplastic carcinoma
- Adenoid cystic carcinoma
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6
Q

Hyperechoic breast mass - Superficial subcutaneous

A 
Benign
- Lipoma
- Hamartoma
- Fat necrosis 
- Hemangioma
- Angiolipoma
- Abscess 
Malignant
- Angiosarcoma
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7
Q

Hyperechoic breast mass - Breast parenchyma

A 
Benign
- Abscess
- Hamartoma
- Galactocele
- Lactating adenoma
- Myofibroblastoma
Malignant
- IDC
- DCIS
- ILS
- Lymphoma
- Angiosarcoma
- Liposarcoma
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8
Q

Diffuse bilateral masses

A

Skin
- NF1
- Melanomas
- Steatocystoma multiplex: lucent/fatty lesions
Parenchyma (rule of multiplicity: benign)
- Breast cysts
- Fibroadenomas
- Posttraumatic oil cysts
- Free silicone injections/granulomas: dense or rim calcified, shadowing/snowstorm on US

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9
Q

Male breast mass

A

Gynecomastia
Pseudogynecomastia
Ductal Ca
Myofibroblastoma

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10
Q

Gynecomastia

A

Physiologic (newborn, puberty, elderly, obese)
Drugs (marijuana, estrogen therapy, antiandrogens, GnRH, spironolactone, thiazide diuretics, antidepressants, prednisone)
Systemic disorders (liver disease [incl cirrhosis], renal disease [incl hemodialysis], COPD, hyper/hypothyroidism, hypogonadism, malnutrition)
Tumour (testicular, adrenal, HCC, lung, pituitary adenoma)
Klinefelter
Idiopathic

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11
Q

Architectural distortion without a central mass (“dark star”)

A 
Lobular carcinoma
IDC-NOS
Radial scar
Posttraumatic scar
Postsurgical scar
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12
Q

Superficial mass

A

Dermal

  • Sebaceous cyst
  • Epidermal inclusion cyst
  • Dermal calcifications
Hypodermal
Fat-originating lesion
- Lipoma
- Angiolipoma
- Fat necrosis
Vascular
- Hemangioma
- Thrombosed vessel
Neurogenic 
Lymphatic or lymph node
Anterior TDLU
- Breast cancer
- Papilloma (peripheral)
- Fibroadenoma
- Adenosis
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13
Q

Pathognomonic calcifications

A 
Popcorn = involuted FA
Lucent centred w/ tattoo sign = dermal
Rod-like = secretory (plasma cell mastitis)
Tram track = vascular
Layering = fibrocystic / milk of calcium
Thin peripheral = oil cyst
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14
Q

Amorphous calcifications

A 
Atypical ductal hyperplasia
DCIS (low grade > intermediate > high)
Fibrocystic change
Flat epithelial atypia
Sclerosing adenosis

Management based on distribution

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15
Q

Coarse heterogeneous calcifications

A

Fibroadenoma
Papilloma
Fibrocystic change
DCIS, usually low to intermediate grade

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16
Q

Fine pleomorphic calcifications

A

DCIS, usually high grade

Fibrocystic change

17
Q

Fine linear branching calcifications

A

DCIS, usually high grade
(Vascular)
(Rod-like)
Fibrocystic change

18
Q

Increased bilateral breast density on subsequent exam

A

Hormone replacement therapy: increased breast size
Endogenous hormonal stimulation (e.g. pregnancy and lactation): increased breast size
Weight loss: decreased breast size
Bilateral breast edema (e.g. congestive heart failure)
Bilateral breast trauma
Bilateral inflammatory breast cancer

19
Q

Bilateral trabecular thickening

A 
CHF
Renal failure / nephrotic syndrome
Cirrhosis / liver disease
Anasarca
SVC syndrome
Lymphadenopathy
20
Q

Unilateral trabecular thickening

A 
Mastitis
Inflammatory breast cancer
Infection: Staph aureus, TB, syphilis, hydatid
Trauma
Radiation
Unilateral lymph node obstruction
Unilateral subclavian vein obstruction
Asymmetric edema from CHF d/t preferential positioning (e.g. sleeping on one side)
21
Q

Skin thickening on mammography (>2mm)

A

Benign
- Infection/mastitis
- Edema: heart/renal failure, hypoalbuminemia, subclavian/brachiocephalic vein thrombosis, SVC syndrome, anasarca
- Lymphedema (post axillary LN dissection)
- Trauma (fat necrosis), burns
- Chronic GVHD
- Breast irradiation (most prominent at 6mo), surgery
- Dermatologic: psoriasis, scleroderma, dermatomyositis, etc.
Malignant
- Inflammatory breast cancer (tumour emboli obstructing dermal lymphatics)
- Locally invasive breast cancer
- Lymphatic obstruction of metastatic axillary nodes
- Metastasis to breast
- Breast lymphoma

22
Q

Unilateral axillary lymphadenopathy

A

Breast carcinoma (+/- occult) with axillary spread
Reactive lymphadenopathy: systemic illness, cat scratch disease
Mets from extra-mammary site
Lymphoma
Granulomatous disease
Silicone from implant rupture or leak

23
Q

Bilateral axillary lymphadenopathy

A

Chronic lymphocytic leukemia (CLL), lymphoma
HIV
Granulomatous disease (sarcoidosis, TB)
Collagen vascular disease (RA, SLE)
Mets (breast & non breast cancers including thyroid, ovarian, pancreatic, H&N)
Reactive

24
Q

Hyperdensities in axillary nodes

A

Mets (breast, ovarian, papillary thyroid)
Granulomatous disease (TB, histo, sarcoid)
Silicone from prior implant rupture
Gold from RA tx (historical)
Tattoos

25
Q

Nipple discharge: bloody

A 
Benign
- Premenopausal: pregnancy (rapidly proliferating breast tissue)
- Postmenopausal: ductal ectasia 
Worrisome
- Intraductal papilloma
- DCIS
- Invasive cancer
26
Q

Nipple discharge: clear or creamy

A

Duct ectasia

27
Q

Nipple discharge: green, white, blue, or black

A

Cysts

Duct ectasia

28
Q

Nipple discharge: milky

A

Physiologic: rapid breast growth during adolescence
Endocrine: lactation, postlactation, pregnancy
Tumour: prolactinoma or other prolactin-producing tumour
Chronic nipple squeezing
Drugs: medications acting as dopamine receptor blockers or dopamine-depleting drugs

29
Q

Benign causes for suspicious non-mass enhancement

A

Fibrocystic changes
PASH
Sclerosing adenosis
Intraductal papilloma

30
Q

Clustered ring enhancement

A 
Malignant:
- Ductal carcinoma in situ
- Necrotic invasive ductal carcinoma 
Benign:
- Fat necrosis
- Inflamed cysts
- Fibrocystic changes

RRC DDx 2 (8 decks)

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