Breast Masses

Question 1

fatty masses and fat containing masses

Answer 1

BIRADS 2
fatty masses: lipoma, oil cyst/fat necrosis
fat containing masses: hamartoma, galactocele, intramammary lymph node

Question 2

lipoma

Answer 2

made of mature adiopocytes; palpable mass

capsule required for diagnosis (thin discrete rim); no peripheral calcifications

Question 3

oil cyst/fat necrosis

Answer 3

post trauma/surgery; commonly has dystrophic calcification

fat sponification –> circumscribed lucen lesion that can peripheraly calcify

Question 4

hamartoma/fibroadenolipoma

Answer 4

benign mass containing fat/glandular tissue

breast within a breast; pseudocapsule

any suspicious calcs within should be worked up

Question 5

galactocele

Answer 5

cystic collection of milk that can present as a palpable mass in a lactating woman; fat fluid level

Question 6

intramammary lymph node

Answer 6

typically upper outer quadrant and adjacent to a vessel

normal findings: characteristic reniform shape with fatty hilum

Question 7

ddx for bilatera enlared lymph nodes

Answer 7

systemic inflammatory conditions/neoplastic disease like CLL or lymphoma

Question 8

solid masses in the breast

Answer 8

fibroadenoma, intraductal papilloma/papillary carcinoma, PASH, breast cancer, giant fibroadenoma, phyllodes, lactational adenoma, multiple intraductal papillomas

Question 9

fibroadenoma

Answer 9

young women, palpable mass

firm, mobile mass with oval/lobular equal density circumscribed mass&raquo_space; coarse popcorn calcifications in older women

Question 10

fibroadenoma BIRADS

Answer 10

BIRADS 2

BIRADS 3/4 depending on imaging characteristics

Question 11

fibroadenoma variants

Answer 11

complex fibroadenoma (proliferative elements and internal cysts >3mm), juvenile fibroadenoma (adolescents, rapid growth), giant fibroadenoma (> 8 cm)

Question 12

phyllodes tumor

Answer 12

rapidly growing tumor seen in older women 40-50yo

large, oval, lobular, circumscribed mass

Question 13

treatment for phyllodes

Answer 13

wide resection given risk of malignancy

Question 14

lactational adenoma

Answer 14

2nd/3rd trimester of pregnancy/postpartum period

freely mobile mass which may be tender if it enlarges rapidly

Question 15

lactational adenoma treatment

Answer 15

regresses after lactation ends; no need for excision/biopsy

Question 16

intraductal papilloma

Answer 16

benign tumor of lactiferous ducts; women 30-50yo

fibrovascular stalk/frond like which torsion will cause pain/bleeding

Question 17

most common cause of pathologic nipple discharge

Answer 17

papilloma; DCIS can also present with bloody nipple discharge

Question 18

intraductal papilloma imaging findings

mammo, galactography, US

Answer 18

mammo: round/oval circumscribed/irregular mass in the subareolar region
galactography: intraductal filling defect

US: solid round/oval mass; fluid filled duct

Question 19

treatment for intraductal papilloma

Answer 19

surgical excision

Question 20

pseudoangiomatous stromal hyperplasia (PASH)

Answer 20

benign stromal/epithelial proliferation thought to be under hormonal control

Question 21

imaging findings of PASH

Answer 21

mammo: large ill-defined round or oval mass

US: hypoechoic/mixed echogenicity oval or irregular mass

Question 22

breast cancer

Answer 22

medullary and mucinous carcinoma may appear as circumscribed round masses or hypoechoic mass on US

internal vascularity

Question 23

giant fibroadenoma size

Answer 23

> 8cm

Question 24

multiple solid masses , pathology?

Answer 24

multiple intraductal papillomas occur in younger patients, usually peripheral and bilateral

less likely to have nipple discharge if solitary, but more likely to cause breast cancer

multiple well circumscribed masses

Question 25

papillomatosis vs juvenile papillomatosis

Answer 25

papillomatosis: microscopic foci of intraductal hyperplasia juvenile papillomatosis: rare cause of mass that resembles a fibroadenoma in adolescents, women <40

Question 26

common skin masses

Answer 26

NF1, steatocystoma multiplex (multiple intradermal oil cysts)

Question 27

NF1 manifestations

Answer 27

AD with pigmentary changes (cafe au lait, lisch nodules), neurofibromas cutaneous neurofibromas are from small nerve tributaries of skin

Question 28

steatocystoma multiplex

Answer 28

rare AD; innumeral fat density masses on the skin

Question 29

simple, complicated, complex cysts

Answer 29

simple: benign, BIRADS 2; round/oval/gently lobulated with circumscribed marchins/anechoic; posterior enhancement; may be aspirated if causing pain/discomfort complicated: BIRADS 3 or aspirated (only BLOODY fluid is sent for cytology); low level internal echoes/layering debris complex: BIRADS 4; cyst with complex features and should be biopsied with core needle and post-biopsy tissue marker

Question 30

masses that appear complex

Answer 30

intracystic carcinoma, intracystic papilloma, cystic phyllodes tumor, solid cancer with central necrosis

Question 31

clustered microcyst

Answer 31

BIRADS 2 if clearly seen/nonpalpable apocrine metaplasia/fibrocystic changes; clustered microcysts 2-5mm separated by thin septae; may evolve into a benign cyst

Question 32

spiculated masses

Answer 32

IDC, invasive lobular carcinoma, tubular carcinoma, radial scar, post lumpectomy changes, abscess, benign breast fibrosis

Question 33

invasive ductal carcinoma

Answer 33

high density spiculated mass; pleomorphic/fine linear branching calcifications present

Question 34

invasive lobular carcinoma

Answer 34

10% of all breast cancers spread via infiltrating pattern surrounding glandular tissue ma present as a mass or subtle architectural distortion; rarely microcalcifications often multifocal or bilateral

Question 35

tubular carcinoma

Answer 35

small spiculated mass; stable over several priors and slow growing radial scar > tubular carcinoma?

Question 36

radial scar

Answer 36

aka complex sclerosing lesion; benign lesion adenosis, hyperplasia, central atrophy resulting in architectural distortion

Question 37

postsurgical scar

Answer 37

postlumpectomy or exchisional biopsy; may cause volume loss or skin retraction

Question 38

abscess

Answer 38

can look like an irregular or spiculated mass

Question 39

benign breast fibrosis/scerosing adnosis/fibrous mastopathy

Answer 39

sclerosing adenosis: lobular hyperplasia; microcalcifications may be present diabetic mastopathy: IDDM with large painless firm breast mass from inflammatory lymphocytes/fibrosis

Question 40

axillary masses

Answer 40

breast cancer nodal mets

Question 41

suspicious features of lymph node mets

Answer 41

round shape, thickened cortex >3mm, eccentrically thickened cortex, focal outwards cortical bulge, hilar indentation or obliteration of hilum