Breast

Question 1

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

Answer 1

lobular carcinoma
IDC-NOS
radial scar
postsurgical scar

Question 2

unilateral axillary adenopathy

Answer 2

1. breast carcinoma with axillary spread
2. reactive lymphadenopathy
3. mets/lymphoma
4. systemic disease
5. granulomatous disease

Question 3

bilateral axillary adenopathy

Answer 3

1. CLL
2. HIV
3. granulomatous disease (sarcoid, TB)
4. collagen vascular disease (RA, SLE)
5. mets (breast & non breast cancers incl thyroid, ovarian, pancreatic, H&N)
6. reactive

Question 4

benign causes for suspicious non mass enhancement

Answer 4

fibrocystic changes
PASH
sclerosing adenosis
intraductal papilloma

Question 5

benign skin thickening on mammography

Answer 5

infection/mastitis
edema: heart/renal failure, hypoalbuminemia, subclavian/brachiocephalic vein thrombosis, SVC syndrome
lymphedema (post axillary LN dissection)
trauma (fat necrosis), burns
chronic GVHD
breast irradiation (most prominent at 6mo), surgery
derm: psoriasis, scleroderma, dermatomyositis, etc

Question 6

malignant skin thickening on mammography

Answer 6

inflammatory breast cancer (tumor emboli obstructing dermal lymphatics)
locally invasive breast cancer
lymphatic obstruction of metastatic axillary nodes
mets to breast
breast lymphoma

Question 7

gynecomastia

Answer 7

physiologic (newborn, puberty, elderly, obese)
drugs (marijuana, GnRH, antiandrogens, spironolactone, thiazide diuretics)
systemic disorders (cirrhosis, COPD, hemodialysis, hyperthyroidism, malnutrition)
tumor (testicular, adrenal, HCC, lung, pituitary adenoma)
Klinefelter
idiopathic

Question 8

clustered ring enhancement

Answer 8

high association with malignancy:

• ductal carcinoma in situ
• invasive ductal & lobular carcinomas (less common)

benign:

• fibrocystic changes
• ruptured/inflamed cysts

Question 9

amorphous calcifications

Answer 9

DCIS (low grade > intermediate > high)
flat epithelial atypia
sclerosing adenosis
fibrocystic change

management based on distribution

Question 10

coarse heterogeneous calcifications

Answer 10

fibroadenoma
papilloma
fibrocystic change
DCIS, usually low to intermediate grade

Question 11

fine pleomorphic calcifications

Answer 11

DCIS, usually high grade
fibrocystic change
(fibroadenoma)
(papilloma)

Question 12

fine, linear or

fine, linear branching calcifications

Answer 12

DCIS, usually high grade
(vascular)
(large rod-like)
fibrocystic change

Question 13

hyperechoic lesions of the breast

Answer 13

To do

https://www.ajronline.org/doi/pdf/10.2214/AJR.12.9263