Breast Masses Flashcards
fatty masses and fat containing masses
BIRADS 2
fatty masses: lipoma, oil cyst/fat necrosis
fat containing masses: hamartoma, galactocele, intramammary lymph node
lipoma
made of mature adiopocytes; palpable mass
capsule required for diagnosis (thin discrete rim); no peripheral calcifications
oil cyst/fat necrosis
post trauma/surgery; commonly has dystrophic calcification
fat sponification –> circumscribed lucen lesion that can peripheraly calcify
hamartoma/fibroadenolipoma
benign mass containing fat/glandular tissue
breast within a breast; pseudocapsule
any suspicious calcs within should be worked up
galactocele
cystic collection of milk that can present as a palpable mass in a lactating woman; fat fluid level
intramammary lymph node
typically upper outer quadrant and adjacent to a vessel
normal findings: characteristic reniform shape with fatty hilum
ddx for bilatera enlared lymph nodes
systemic inflammatory conditions/neoplastic disease like CLL or lymphoma
solid masses in the breast
fibroadenoma, intraductal papilloma/papillary carcinoma, PASH, breast cancer, giant fibroadenoma, phyllodes, lactational adenoma, multiple intraductal papillomas
fibroadenoma
young women, palpable mass
firm, mobile mass with oval/lobular equal density circumscribed mass»_space; coarse popcorn calcifications in older women
fibroadenoma BIRADS
BIRADS 2
BIRADS 3/4 depending on imaging characteristics
fibroadenoma variants
complex fibroadenoma (proliferative elements and internal cysts >3mm), juvenile fibroadenoma (adolescents, rapid growth), giant fibroadenoma (> 8 cm)
phyllodes tumor
rapidly growing tumor seen in older women 40-50yo
large, oval, lobular, circumscribed mass
treatment for phyllodes
wide resection given risk of malignancy
lactational adenoma
2nd/3rd trimester of pregnancy/postpartum period
freely mobile mass which may be tender if it enlarges rapidly
lactational adenoma treatment
regresses after lactation ends; no need for excision/biopsy
intraductal papilloma
benign tumor of lactiferous ducts; women 30-50yo
fibrovascular stalk/frond like which torsion will cause pain/bleeding
most common cause of pathologic nipple discharge
papilloma; DCIS can also present with bloody nipple discharge
intraductal papilloma imaging findings
mammo, galactography, US
mammo: round/oval circumscribed/irregular mass in the subareolar region
galactography: intraductal filling defect
US: solid round/oval mass; fluid filled duct
treatment for intraductal papilloma
surgical excision
pseudoangiomatous stromal hyperplasia (PASH)
benign stromal/epithelial proliferation thought to be under hormonal control
imaging findings of PASH
mammo: large ill-defined round or oval mass
US: hypoechoic/mixed echogenicity oval or irregular mass
breast cancer
medullary and mucinous carcinoma may appear as circumscribed round masses or hypoechoic mass on US
internal vascularity
giant fibroadenoma size
> 8cm
multiple solid masses , pathology?
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
papillomatosis vs juvenile papillomatosis
papillomatosis: microscopic foci of intraductal hyperplasia
juvenile papillomatosis: rare cause of mass that resembles a fibroadenoma in adolescents, women <40
common skin masses
NF1, steatocystoma multiplex (multiple intradermal oil cysts)
NF1 manifestations
AD with pigmentary changes (cafe au lait, lisch nodules), neurofibromas
cutaneous neurofibromas are from small nerve tributaries of skin
steatocystoma multiplex
rare AD; innumeral fat density masses on the skin
simple, complicated, complex cysts
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
masses that appear complex
intracystic carcinoma, intracystic papilloma, cystic phyllodes tumor, solid cancer with central necrosis
clustered microcyst
BIRADS 2 if clearly seen/nonpalpable
apocrine metaplasia/fibrocystic changes; clustered microcysts 2-5mm separated by thin septae; may evolve into a benign cyst
spiculated masses
IDC, invasive lobular carcinoma, tubular carcinoma, radial scar, post lumpectomy changes, abscess, benign breast fibrosis
invasive ductal carcinoma
high density spiculated mass; pleomorphic/fine linear branching calcifications present
invasive lobular carcinoma
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
tubular carcinoma
small spiculated mass; stable over several priors and slow growing
radial scar > tubular carcinoma?
radial scar
aka complex sclerosing lesion; benign lesion
adenosis, hyperplasia, central atrophy resulting in architectural distortion
postsurgical scar
postlumpectomy or exchisional biopsy; may cause volume loss or skin retraction
abscess
can look like an irregular or spiculated mass
benign breast fibrosis/scerosing adnosis/fibrous mastopathy
sclerosing adenosis: lobular hyperplasia; microcalcifications may be present
diabetic mastopathy: IDDM with large painless firm breast mass from inflammatory lymphocytes/fibrosis
axillary masses
breast cancer nodal mets
suspicious features of lymph node mets
round shape, thickened cortex >3mm, eccentrically thickened cortex, focal outwards cortical bulge, hilar indentation or obliteration of hilum
