Breast Pathology Flashcards
What typically benign characteristics does a mucinous or colloid carcinoma demonstrate?
Posterior acoustic enhancement
“Breast within a breast” is a classic characteristic on mammo for what tumor?
Fibroadenolipoma
Normal skin thickness
2mm or less
Highly speculative calcifications is a characteristic typical of what?
Ductal Carcinoma in Situ (DCIS)
Scaling and redness of the nipple, often confused with eczema is:
Paget’s disease if the nipple
May displace the nipple:
Juvenile fibroadenoma
Oil cysts may be the result of
Fat necrosis
The most common abnormality involving the breast is:
Fibrocystic breast changes
Most common metastatic lesion from the breast :
Metastatic Breast Cancer from the other breast
Which tumor originates from the lining of the lactiferous duct?
Papilloma
Medullary Carcinomas are often confused with:
Fibroadenomas
What effect does a benign mass usually have on fibrous planes within the breast?
Benign masses have no effect on adjacent tissue planes
What tumor is always considered invasive breast carcinoma?
Medullary carcinoma
A BIRADS 5 tumor likely to be a carcinoma is:
Highly suggestive of malignancy
Well defined, thick walled lesion with few floating internal echoes and septations may represent:
An inflammatory cyst
Most common post surgical breast complication
Seroma
Phyllodes tumors have a higher likelihood of being malignant when they are greater than
3 cm and exhibit cystic spaces
Which type of breast cancer presents hystologically with its cells infiltrating surrounding tissue in a uniform, linear arrangement
Invasive Lobular Carcinoma
How is DCIS typically discovered?
Microcalcifications on the mammogram
Benign mass characteristics:
Smooth contours and a thin echogenic capsule
Polymastia refers to:
The presence of accessory glandular tissue
Approximately what percentage of breast pathology do fibroadenomas have
50%
What differentiates malignant phyllodes from the benign version?
Patients with Malignant Phyllodes are typically older than patients with benign Phyllodes tumor
Acute infection of the breast occurs most often:
During lactation
What does “secondary primaries” mean?
Breast cancer recurrence
Characteristics of simple cysts
Smooth contour with well defined borders
Cystic lesion less than 2 mm must be watched carefully because:
They are too small to demonstrate all the characteristics of a simple cyst
“Swiss cheese” appearance is a description used for what tumor?
Juvenile papilloma
Tumor characteristics most consistent with malignancy:
Stellar pattern, hypoechogenicity and angular margins
Fat necrosis usually occurs most frequently following breast trauma
True
Which group of invasive breast cancers has the worst prognosis?
Invasive Ductal Carcinoma (NOS)
Approximately what percentage of vascularity do malignant breast masses usually have?
30% (Hypervascular)
LCIS is not considered a true cancer
True
Lipomas are more compressible than fibroadenoma
True
Patient with h/o Burkett’s, multiple palpable masses in the Rt axilla and hypoechoic mass with irregular boarders in the Rt breast is most likely to have:
Breast lymphoma
Which type of breast cancer contains both glandular and non glandular patterns with epithelial or mesenchymal tissue component?
Metaplastic Carcinoma
Micro and macrocystic breast disease makes up approximately what percent of all lesions identified clinically and/or on mammogram?
25%
Most common benign soft tissue tumor of the breast:
Lipoma
Most common type of invasive carcinoma
Invasive Ductal Carcinoma
Galactoceles may be simple or complex in appearance
True
A patient with a breast that does not include a nipple or areola but does contain glandular tissue is said to have:
Athelia
Tubular Adenomas and Fibroadenomas may be differentiated by what ultrasound appearance?
Presence of tightly packed, punctuate calcifications
Multicentric breast carcinoma is:
All the tumors formed separately in different areas of the breast
Fibroadenomas rarely become malignant
True
Puerperal mastitis is most commonly precipitated by
Milk Stasis
Highest percentage of malignant breast tumors occur in which breast location
Upper Outer Quadrant
Hyperechogenicity in a mass is usually a benign characteristic
True
Malignant tumor vascularity displays:
Multiple shunts
On mammogram there’s a new, fairly well circumscribed density in the UOQ. This is a BIRADS category:
0
Most common cause of bloody nipple discharge
Papillomas
Phyllodes tumor with cystic spaces is suspicious for
Malignant solid breast pathology
Characteristics of a breast abscess:
Fever, a painful, swollen breast. Overlying skin is red and warm to the touch with complex fluid collection seen on ultrasound
*Specialized type of invasive Ductal Carcinoma
Tubular carcinoma
Defined as “Epithelial proliferation that is still confined to the TDLU”
Non invasive carcinoma
Multifocal breast cancer is defined as
Multiple foci of cancer in the same quadrant of the breast
Current average of local breast cancer recurrence rate at 5 years following lumpectomy
4%
Post lumpectomy surgical scars are carefully monitored for tumor recurrence. Recurrence may be suspected if
The size of the scar increases after 2 stable examinations
In the lactating patient, breast tissue often appears _______ in comparison to the non-lactating patient.
More echogenic
Which type of calcification is considered most suspicious for malignancy of the breast?
Fine Linear pleomorphic calcifications
What is the benign lesion that may transform into an oil cyst and will always demonstrate posterior acoustic enhancement?
Galactocele
An oil cyst may mimic the appearance of:
Carcinoma
Characterized by thrombophlebitis of the subcutaneous veins of the breast.
Mondor’s Disease of the breast
Not a true cancer but Considered a marker for increased risk of breast carcinoma
LCIS
Usually associated with a focus of DCIS that demonstrates as a small spiculated mass and is characterized microscopically by relatively uniform angulated small ducts which invade the mammary stroma
Tubular Carcinoma
Describe the spread of Mets breast cancer from most common to least common
Contralateral breast, bone, lung, liver
Approximate percentage of breast cancer located in the retroareolar region
17%
BIRADS categories
1: Negative
2: Benign
3: Probably Benign
4: Suspicious
5: Highly Suggestive of Malignancy
6: Known Biopsy-Proven Malignancy
Fibrous Ridge is considered a pseudomass
True
Malignant lesions tend to have what effect on tissue planes?
Cross the plane in an infiltrative fashion. Interrupts the tissue plane or converges towards it
Cysts are most common in women aged:
35-54
Approximately what percentage of Fibroadenomas have a complex appearance?
33%
Solitary papillomas usually are located:
Subareolar
Skin thickening can be related to breast trauma
True
Why do Fibroadenomas often significantly increase in volume during pregnancy and lactation?
They are affected by rising estrogen levels
Sebaceous cysts are aka
Epidermal inclusion cysts
BIRADS final assessment of 1 means:
The mammo and/or ultrasound does not demonstrate any pathology
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is associated with which type of breast implants?
Textured surface implants
What is duct extension?
Tumor extends in a single duct toward the nipple
Most common form of supernumerary breast tissue is:
Polythelia
Which characteristic indicates the highest positive predictive value for malignancy?
Angular margins
Increased breast density increases the patients risk of breast cancer.
True
What is the oval macrolobulated mass with fibrotic septae that can grow rapidly and will most likely regress when lactation ceases.
Lactating adenoma
Periductal mastitis can be confused with:
Duct ectasia
A 28 y/o patient presents to the department with multiple firm to hard palpable lumps that are easily movable. She is type 1 diabetic. She most likely has:
Diabetic fibrous mastopathy
What percentage of intraductal carcinomas form a stellar configuration?
66%
Medullary carcinoma may be confused clinically with:
Fibroadenoma
Most common extramammary Mets to the breast
Malignant melanoma
Bilateral regional lymph node assessment should be included in the routine US protocol on patients who:
Had a h/o Breast cancer who have had a lumpectomy
Benign breast lesions are usually parallel to the chest wall
True
Peau d’Orange is caused by:
The blockage of lymph glands due to an underlying cancer. (Usually inflammatory breast carcinoma)
The most common location for supernumerary breast tissue is:
Abdomen
A classic fibroadenoma should be biopseid if greater than:
4cm
Fat necrosis is most common in_____ with large breasts.
Obese women
Sonographic appearance of a high grade invasive Ductal carcinoma
Hypoechoic, angular margins and posterior acoustic enhancement
Most aggressive form of DCIS is:
High grade or Comedo
Lymphoma found in pregnant and lactating women that has a poor prognosis
Burkitt’s Lymphoma
Absence of the nipple and areola in the presence of glandular tissue
Athelia
Clinicians describe malignant masses as “firm, or hard and gritty” due to the:
Fibroelastic host response
Which invasive breast cancer has an excellent prognosis with lymph node involvement being uncommon
Adenoid cystic carcinoma
Proliferation of the ductules and lobules:
Adenosis
Which type of cyst demonstrates a teacup appearance
Milk of calcium cyst
Solid benign breast mass that displays tightly packed punctuate calcifications scattered through the mass
Tubular adenoma
Sclerosing Duct Hyperplasia is aka
Radial Scar
Hamartomas aka
Fibroadenolipoma or Adenifibrolipoma
Usually benign lesion of the breast, not related to trauma or surgery. If visible on US it appears as an ill-defined subtle area of architectural distortion, or irregular shape hypoechoic mass with or w/o posterior shadowing
Radial scar
Br Ca recurrence receptors from highest to lowest:
Triple-Negative disease (6.9%)
Estrogen receptor-Negative Disease (4.7%)
HER2-Positive disease (4.7%)
Triple-positive disease (3%)
The underlying cause of radial scars is:
Unknown
