Breast Flashcards
Bilateral Increased Breast Density
1) Pregnancy/Lactation
2) Exogenous Estrogen
3) Weight Loss
4) CHF/CKD/Liver Dz
5) Lymphedema (axillary dissection)
6) Meds (antipsychotics)
7) Cancer
8) Pituitary Prolactinoma
Trabecular & Skin Thickening
1) Cancer
- Diffuse invasive carcinoma
- Inflammatory carcinoma
2) Lymphedema (axillary dissection)
3) Radiation Rx
4) Mastitis
5) Generalized Edema
- CHF
- CKD
- Cirrhosis
Spiculated Masses
Malignant - IDC - ILC - Tubular carcinoma Benign - Post Bx scar - Radial scar - Sclerosing adenosis - Atypical fat necrosis - Atypical FCC - Desmoid tumor
Rounded Masses
Malignant - IDC - Medullary carcinoma - Papillary carcinoma - Mucinous carcinoma - Intracystic carcinoma - Adenoid cystic carcinoma - Mets (breast, lymphoma, melanoma) Benign - Cyst - Fibroadenoma - Phyllodes tumor - Papilloma - Sebaceous cyst - Epidermoid inclusion cyst - Lactating adenoma
Indistinct Masses
Malignant - IDC - ILC - Lymphoma - SCC - Sarcoma Benign - PASH - Focal fibrosis
Fat-Containing Masses
Malignant - Liposarcoma Benign - Intramammary LN - Galactocele - Hamartoma - Lipoms - Oil cyst/Fat necrosis - Fat lobule
Fluid-Containing Masses
Malignant - Necrotic cancer - Intracystic carcinoma Benign - Cyst - Abscess - Hematoma - Galactocele - Seroma - Sebaceous & Epidermoid cysts
Amorphous Calcifications
1) FCC (most likely)
2) Sclerosing Adenosis
3) Papilloma
4) Fibroadenoma
5) ADH/ALH
6) DCIS (low-grade)
Coarse Heterogeneous Calcifications
1) FA
2) Papilloma
3) Fat necrosis
4) FCC
5) DCIS (low to intermediate grade)
Fine Pleiomorphic Calcifications
1) FCC
2) DCIS (high-grade)
3) FA (less likely)
4) Papilloma (less likely)
Fine Linear/Linear Branching Calcifications
1) High-Grade DCIS
2) Atypical Secretory Calcifications
Oval, Circumscribed, Hypoechoic US Mass
1) FA
2) Phyllodes
3) PASH
4) Lactating Adenoma
5) Medullary carcinoma
Large, Necrotic Mass
1) IDC
2) Phyllodes
3) Sarcoma
4) Lymphoma
Subareolar Mass
1) Papilloma
2) Paget’s Dz
3) Resolving Seroma/Hematoma Post-Trauma
4) Papillary Carcinoma
Architectural Distortion
Malignant - ILC Benign - Radial scar - Post Bx/surgery changes - Fat necrosis - XRT changes - FCC
Global Asymmetry
Malignant - ILC Benign - Normal variant - Diabetic mastopathy - Post-treatment changes
Calcified LNs
1) Treated lymphoma
2) Mets (ovarian, mucinous GI)
3) RA Gold Therapy
4) Granulomatous Dz
5) Silicone Granuloma
Single Dilated Duct/Bloody Nipple Discharge
1) Ductal Ectasia
2) Papilloma
3) Malignancy
- DCIS
- IDC
- Papillary carcinoma
Masses Associated w/ Implants
1) Breast Cancer
2) Silicone Granuloma
3) BIA-ALCL
Subtypes of IDC
1) IDC-NOS
2) Tubular
3) Medullary
4) Mucinous
5) Papillary
Subtypes of DCIS
1) Comedo
2) Solid
3) Cribiform
4) Micropapillary
Etiology of Gynecomastia
1) Absolute Inc in Estrogen (tumors)
- Germ cell tumor
- HCC
- Pituitary tumor
- Adrenal cortical tumor
2) Absolute Inc in Estrogen (Rx)
- Prostate Ca
- Baldness
3) Absolute Inc in Estrogen (inc precursors)
- Cirrhosis
- Hyperthyroidism
2) Relative Increase in Estrogen
- Testicular failure/atrophy
- Klinefelter syndrome
- Refeeding after malnutrition
3) Drugs/Meds
- Spironolactone
- Propecia
- Dilantin
- Marijuana
Male Breast Masses
1) Benign
- Lipoma (most common)
- Gynecomastia (most common reason for imaging)
- Pseudogynecomastia
- Epidermoid inclusion cyst
- papilloma
- Diabetic mastopathy
- Leiomyoma
- Granular cell tumor
2) Malignant
- IDC
- Mets
- Lymphoma
- Sarcoma
Pregnancy-Related Masses
1) Benign (vast majority)
- Lactating adenoma
- Galactocele
- FA
- Mastitis
2) Pregnancy-Related Malignancy (< 1yr)
Breast Masses in Young Pts (< 30yo)
1) Benign
- FA
- Phyllodes
- Granular cell tumor
- Lactating adenoma
- FCC
- Hamartoma
- Juvenile hypertrophy
- Juvenile papillomatosis
2) Malignancies
- Malignant Phyllodes (most common)
- Mets
- Lymphoma/Leukemia
- Angiosarcoma
Recurrence/Residual Disease Trivia
1) Local recurrence risk 6-8% after BCS + XRT
- Risk inc to 35% w/o XRT
- Peak incidence 4yr post-Tx
2) RFs for Recurrent Dz
- Young pt
- Positive surgical margins
- Lymphovascular invasion
- Multicentric
3) Calcifications
- Residual calcs associated w/ 60% recurrence rate
- New calcs benign immediately post-op
- Recurrence calcs occur few years post-Tx
4) Tissue Flap Recurrence
- Residual superficial breast
- Along scar line
- Axilla
- Will not recur along flap
Nipple Discharge
Bloody, Spontaneous Discharge - Multiple ducts --> benign - Single duct --> papilloma vs. cancer Milky Discharge --> pituitary adenoma Ductal Ectasia --> discharge in post-menopause
Major Duct Lesions
1) Ductal Ectasia
2) Papilloma
3) Papillary Carcinoma
Terminal Duct Lesions
1) DCIS
2) IDC
3) ADH
4) Ductal Adenoma
5) Radial Scar
6) Tubular Carcinoma
7) Medullary Carcinoma
8) Mucinous Carcinoma
9) SCC
10) Adenoid Cystic Carcinoma
Lobule Lesions
1) FA
2) Lactating Adenoma
3) Cyst
4) Sclerosing Adenosis
5) Galactocele
6) Juvenile Papillomatosis
7) ILC
8) LCIS
9) Juvenile Fibroadenoma
10) Lobular Neoplasia
Stromal Lesions
1) Fat Necrosis
2) Lipoma
3) Hamartoma
4) Fibrosis
6) PASH
7) Abscess
8) Mets
9) Diabetic Mastopathy
10) Desmoid
11) Lymphoma
12) Phyllodes
