Breast Pathology (Module 2 Unit 4A) Flashcards
What are the most common cause of breast lumps in women 35-50 years of age?
Cysts
What is commonly found in the fibrocystic change (FCC)?
Cysts
What is the most common benign diffuse breast condition?
Fibrocystic Change
What are the 4 key features of FCC?
Hyperplasia, adenosis, stromal fibrosis, and cyst formation
In FCC, describe the appearance of nodular adenosis and sclerosing adenosis.
nodular adenosis - mass like
sclerosing adenosis - difficult to differentiate from cancer (presense of calcs, lobulation, irregular)
Describe an acorn cyst.
Non dependent echogenic layer, shows movement of fat layer to differentiate from other pathologies)
What is PAM?
Abnormal change/growth of cells, associated with fibrocystic change, echogenic echoes (crescent layer, NON-MOBILE)
What is the most common benign mass in lactating patients?
Galactocele
What type of cyst can a Galactocele become?
Lipid (oil) cyst
If you move a patient around who has a galactocele, what will it look like sonographically?
Fluid-fat levels with change with pt position, internal echoes (milk-laden contents) or completely anechoic
What are sebaceous cysts and epidermal inclusion cysts?
Benign masses from skill layers, results from obstructed sebaceous (oil-producing) glands or hair follicles, in a superficial location
What type of cyst contains sebum or keratin?
Sebaceous cyst/epidermal inclusion cyst
What type of cyst contains sebum, is superficial, and shows as a darkening of the pore of the obstructed gland?
Sebaceous cyst
What is mastitis? When is it common?
Inflammation of the breast and is most common during pregnancy and lactation
A patient comes in with a swollen breast, painful to the touch boob, nipple discharge, and their breast is hard – what might be the diagnosis?
Mastitis
What is the most common place for a breast abscess?
Subareolar
What is Mondor disease?
Acute thrombophlebitis of the superficial veins of the breast or chest wall.
What are the sonographic appearances of Mondor disease?
- Dilated tubular vein with internal echoes from clot
- Incomplete compressibility
- Absent blood flow or partial absence of flow
How can hematomas happen in the breast?
Result of trauma/injury and subsequent vessel damage
What is a seroma?
Collection of serous fluid
What is the sonographic appearance of a seroma?
- fluid collection (anechoic or low level echoes/septations)
- obvious posterior enhancement
- typically confirms to surgical cavity
- absence of internal vascularity on doppler
What is fat necrosis?
Inflammatory, ischemic process due to the breast trauma (injury, radiotherapy, surgery, inflammation)
What are the risk factors for fat necrosis?
Obesity (large fatty breasts) , surgical excisions follow by radiation, diabetes (spontaneous fat necrosis)
Why is the clinical history important for fat necrosis?
Signs and symptoms mimic cancer - palpable area, skin thickening, dimpling, nipple retraction
What is sonographic appearance of fat necrosis?
Variable; can evolve to a solid, suspicious appearing lesion due to fibrosis and granuloma formation (fibrotic fat necrosis - spiculated/irregular, hypoechoic shadowing mass)
What are the sonographic findings for a post surgical scar?
- hypoechoic area with acoustic shadowing
- skin thickening or retraction is common
- transducer pressure can flatten out the scar and reduce shadowing
- diminish with time on serial scans
What are benign characteristics for a breast mass? (4)
- hyperechogenicity
- wider than tall
- multilobulated
- thin, echogenic capsule
What are the malignant characteristics for a breast mass? (7)
- spiculation
- taller than wide
- angular margins
- markedly hypoechoic
- shadowing
- calcifications
- duct extensions
What is the best modality to examine nipple discharge?
Galactography
What is considered ‘low risk’ for nipple discharge? (3)
- bilateral
- multiple duct orifices
- milky/greenish
What is considered an ‘increased risk’ for nipple discharge? (5)
- unilateral
- spontaneous
- single duct orifice
- clear, serous, or slight to frank blood
- associated with skin or nipple changes
Name 6 benign solid breast masses.
- fibroadenoma
- adenoma/secretory adenoma
- phyllodes tumour
- hamartoma
- lipoma
- intraductal papilloma/intracystic papilloma, and pappilomatosis
What is the most common benign SOLID tumour?
Fibroadenoma
What is an estrogen-induced tumour that is slow-growing, and more commonly solitary?
Fibroadenoma
What is the sonographic appearance of a fibroadenoma?
- oval (wider than tall)
- thin echogenic capsule
- isoechoic or hypo compared to fat
- solid
- may calcify over time and show macrocalcs
What is more common: adenomas or fibroadenomas?
Fibroadenomas
What type of adenomas are present during pregnancy or the lactation period due to elevated hormones?
Secretory adenomas
What is the sonographic appearance of an adenoma?
- oval, circumscribed, parallel-orientated (wider than tall)
- internal areas of increased echogenicity
- increased vascularity on doppler
What is a rare fibroepithelial tumour that is leaf-shaped?
Phyllodes tumour (Phylloides)
What is the average age to develop Phylloides?
Around late 40s
What leaf-shaped tumour has a malignant potential if not removed?
Phyllodes tumour
What is the sonographic appearance of Phyllodes Tumour?
- cystic spaces
- wider than tall
- thin echogenic capsule
- isoechoic or hypo compared to fat
- solid
- calcs are not typical
What is a hamartoma?
A benign tumor like malformation, a pseudotumor
What are the signs and symptoms of a hamartoma?
Unilateral and measure over 3cm when diagnosed, painless, soft/rubbery
What are the 3 types of benign papillary lesions?
- Intraductal (large duct) papilloma
- Peripheral papillomatosis
- Juvenile papillomatosis
What is the most common benign papillary lesion?
Intraductal papilloma
Where does intraductal papilloma develop?
Centrally behind/close to the areola, within a major lactiferous duct
What are the signs and symptoms of intraductal papilloma?
- bloody or watery discharge (#1 cause of spontaneous bloody nipple discharge from a single breast duct)
- asymptomatic
Should an intraductal papilloma be removed, or left alone?
Removed, due to the increase risk of breast cancer
What is the sonographic appearance of an intraductal papilloma?
- dilation of the duct
- soft tissue mass
- vascularity in the stalk
- radial scanning allows better visualization
Where is the most common location for malignant breast masses to develop?
UOQ
What are the contributing factors to a breast malignancy?
- increased age
- female
- personal or fam history of breast ca
What genetics significantly increase the risk of developing breast cancer?
BRCA1 and BRCA2
What are the grades of cancer cells and which is worst?
Grades 1-3, 3 being the worst
What is non-invasive cancer termed?
Carcinoma in situ - confined within the space
What are two types of carcinoma in situ?
Lobular Carcinoma In Situ (LCIS)
Ductal Carcinoma In Situ (DCIS)
What in situ cancer isn’t considered a malignancy and is not treated clinically as a true cancer but is instead a significant increased future risk of developing cancer?
LCIS
What is the most common noninvasive breast cancer?
DCIS
Ductal Caricnoma In Situ (DCIS) is best detected using which modality?
Mammography
What is the mammo and US appearance for DCIS?
Mammo - microcalcs in a ground or following a linear/branching pattern
Sonography - microcalcs, distended duct, hypoechoic mass
What is Paget disease?
Cancer of the epidermis of the nipple
What cancer initiates Paget disease?
DCIS
What are the signs and symptoms of Paget disease?
- eczema-like crusting of the nipple areola, redness or ulceration
- nipple discharge and itching
What is the most common breast cancer of all time?
Invasive Ductal Carcinoma (IDC)
What appears in the advanced stages of IDC (invasive ductal carcinoma?
Skin dimpling, nipple retraction, or breast contour changes
What does IDC look like on mammo?
Asymmetric, irregular, radiodense mass with spiculated margins; clustered microcalcs are common; thick/straight coopers ligaments
What is the sonographic appearance of IDC?
- irregular shaped
- hypoechoic (MARKEDLY hypoechoic)
- spiculated margins
- clustered microcalcs
- shadowing
What is the 2nd most common invasive breast malignancy?
Invasive Lobular Carcinoma (ILC)
What type of growth pattern does ILC have?
Diffuse
What are the s/s of ILC?
- hard, fixed, mass
- may feel like an area of nonspecific thickening
- tissues can retract, “shrinking breast” and nipple retraction
Calcs are not common in which malignancy?
ILC (invasive lobular carcinoma)
What type of carcinoma is rare, well marginated, occurs in young women, central necrosis is common, grows rapidly, and is located UOQ?
Medullary carcinoma
What is a mucinous carcinoma that is rare, more common in elderly` women, and is slow growing?
Colloid carcinoma
What carcinoma may mimic a fat lobule or lipoma, but is less compressible?
Colloid carcinoma
What type of carcinoma is more common in men?
Papillary carcinoma
What type of carcinoma has a high incidence in men and also has bloody nipple discharge?
Papillary carcinoma
Which type of carcinoma is small, slow growing, rare, prominent reactive fibrosis, and has a good prognosis?
Tubular carcinoma
What is inflammatory carcinoma?
Occurs when highly invasive cancer infiltrates the lymphatics of the skin, abrupt onset, rapid progression (aggressive), poor long term prognosis
What are the signs and symptoms of inflammatory carcinoma?
- red, warm, and edematous skin
- orange peel appearance
- painful and hard breast
What is a differential diagnosis for inflammatory carcinoma?
Abscess, mastitis
What is the sonographic appearance of inflammatory carcinoma?
- hypoechoic shadowing mass
- thick, echogenic skin
- dilated lymph vessels and veins
- hypervascularity of surrounding tissue
- edema
What is the first site of mets spread from a primary breast cancer?
The ipsilateral axillary lymph nodes (same side axillary nodes)
What lymph node is at most risk for mets?
Sentinel node
What are the most frequent sites for primary breast cancer to metastasize to?
bone, liver, lung, brain
Where do mets FROM breast go? (4; 3 nodes, 1 ect)
- axillary LN (most common)
- internal mammary nodes
- supraclavicular nodes
- distant sites (bone, liver, lung, brain)
Where do mets TO breast come from?
- M/C from contralateral breast
- 2nd M/C from melanoma
What are the most indicative features of benign lymph nodes associated with the breast? (6)
- oval, kidney shape
- circumscribed smooth margins
- symmetric hypoechoic outer cortex
- hyperechoic fatty hilum
- hilar doppler flow
- intramammary nodes less than or equal to 1cm
What are the most indicative features of malignant or worrisome lymph nodes associated with the breast? (6)
- rounded, irregular shape
- enlarged diameter
- eccentric cortical thickening
- displaced, indented or absent echogenic fatty hilum
- markedly hypoechoic cortex
- heterogenous cortex
- indistinct cortical wall
- transcapsular blood flow
- side asymmetry
What is the most common breast abnormality in men?
Gynecomastia
An increased estrogen-testosterone ratio may be associated with what in men?
Gynecomastia
What is pseudogynecomastia?
Male breast enlargement caused by excessive fat deposition without subareolar ductal proliferation
What are the signs and symptoms of gynecomastia?
- soft to mildly firm
- mildly tender
- area of firmness
- nodularity beneath the areola
Male breast cancer has a strong association to which syndrome?
Klinefelter syndrome
Where is primary male breast cancer typically located?
Beneath the areola
What is the most common primary tumour for men?
IDC
