Breast Flashcards
Breast cancer types
Ductal
- DCIS
- Invasive
- No special type
- Tubular
- Mucinous
- Medullary
- Papillary
Lobular
- LCIS
- InvasiveHigh risk lesions – must be surgically excised
Radial scar ADH: Atypical ductal hyperplasia LCIS: Lobular carcinoma in situ ALH: Atypical lobular hyperplasia Papilloma
Smooth well-defined mass
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
Breast lesion containing fat
Lipoma / lipomatous pseudomass Fat necrosis Hamartoma (fibroadenolipoma) Lymph node Galactocele Angiolipoma
Cystic lesions
Cyst Hematoma Abscess Papillary lesion - Encapsulated (intracystic) papillary carcinoma - DCIS - Invasive carcinoma Malignancy - Tubular adenoma - Mucinous adenocarcinoma - Metaplastic carcinoma - Adenoid cystic carcinoma
Hyperechoic breast mass - Superficial subcutaneous
Benign - Lipoma - Hamartoma - Fat necrosis - Hemangioma - Angiolipoma - Abscess Malignant - Angiosarcoma
Hyperechoic breast mass - Breast parenchyma
Benign - Abscess - Hamartoma - Galactocele - Lactating adenoma - Myofibroblastoma Malignant - IDC - DCIS - ILS - Lymphoma - Angiosarcoma - Liposarcoma
Diffuse bilateral masses
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
Male breast mass
Gynecomastia
Pseudogynecomastia
Ductal Ca
Myofibroblastoma
Gynecomastia
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
Architectural distortion without a central mass (“dark star”)
Lobular carcinoma IDC-NOS Radial scar Posttraumatic scar Postsurgical scar
Superficial mass
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
Pathognomonic calcifications
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
Amorphous calcifications
Atypical ductal hyperplasia DCIS (low grade > intermediate > high) Fibrocystic change Flat epithelial atypia Sclerosing adenosis
Management based on distribution
Coarse heterogeneous calcifications
Fibroadenoma
Papilloma
Fibrocystic change
DCIS, usually low to intermediate grade
Fine pleomorphic calcifications
DCIS, usually high grade
Fibrocystic change
Fine linear branching calcifications
DCIS, usually high grade
(Vascular)
(Rod-like)
Fibrocystic change
Increased bilateral breast density on subsequent exam
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
Bilateral trabecular thickening
CHF Renal failure / nephrotic syndrome Cirrhosis / liver disease Anasarca SVC syndrome Lymphadenopathy
Unilateral trabecular thickening
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)
Skin thickening on mammography (>2mm)
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
Unilateral axillary lymphadenopathy
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
Bilateral axillary lymphadenopathy
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
Hyperdensities in axillary nodes
Mets (breast, ovarian, papillary thyroid)
Granulomatous disease (TB, histo, sarcoid)
Silicone from prior implant rupture
Gold from RA tx (historical)
Tattoos
