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Breast Sonography > Malignant Disease > Flashcards

Malignant Disease Flashcards

1
Q

🎗 Most breast cancers arise from the…

A

TDLU.

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2
Q

🎗 A larger percentage of breast cancers are located in the __ quadrant.

A

upper outer

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3
Q

🎗 The theory is that the ___ of the TDLU gives rise to hyperplasia.

A

normal epithelium

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4
Q

__ may give rise to cancer cell growth within the dut, known as ductal carcinoma in situ (DCIS).

A

aytpical hyperplasia

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5
Q

__ may give rise to invasive carcinoma which can __.

A

DCIS; metastasize to other organs

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6
Q

🎗 __ is the most common cancer in women.

A

breast cancer (more often than colon uterine ovarian and cervical combined)

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7
Q

🎗 Breast cancer is the second leading cause of cancer death in women, exceeded only by…

A

lung cancer.

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8
Q

Women rarely get cancer before age…

A

30.

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9
Q

Male breast cancer makes up less than __% of the total

A

1%

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10
Q

🎗 Breast cancer progression order (5)

A
  1. normal epithelium
  2. hyperplasia
  3. DCIS
  4. Invasive carcinoma
  5. Metastasis
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11
Q

One in every __ women will develop breast cancer.

A

8

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12
Q

The dramatic decrease in breast cancer cases from 2002 to 2003 was attributed to…

A

the reduction in the use of HRT following the NIH’s study.

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13
Q
  1. Gender
  2. Age
  3. Family Hx of Breast cancer
  4. Personal Hx of Breast cancer
  5. Menstrual periods
  6. Childbearing
  7. Hormonal influence
  8. Personal Hx of cancer
  9. Biopsy finding of atypical hyperplasia
  10. Radiation therapy
  11. Obesity
A

Breast cancer risk factors

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14
Q

🎗 This is the most significant risk factor for breast cancer.

A

gender

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15
Q

🎗 This is the second strongest risk factor for breast cancer.

A

age

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16
Q

__% of patients with breast cancer have no family hx.

A

75%

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17
Q

BRCA genes mutations increase the risk of __ and __.

A

breast cancer; ovarian cancer

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18
Q

Early menarche/late menopause [increase/decrease] breast cancer risk.

A

increase

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19
Q

Nulliparity/late 1st pregnancy [increase/decrease] breast cancer risk.

A

increase

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20
Q

Use of oral contraceptive/HRT [increase/decrease] breast cancer risk.

A

increase

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21
Q

Healthy diet/exercise [increase/decrease] breast cancer risk.

A

decrease

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22
Q

The current 5-year survival rate for non-invasive breast cancer is __%.

A

98%

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23
Q

🎗 This is the most common non-invasive cancer and the 2nd most common breast cancer overall.

A

DCIS

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24
Q

🎗 DCIS arises from the…

A

TDLU.

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25
Q
  1. arises from the TDLU
  2. usually confined to one lobe or segment
  3. a precursor to invasive ductal carcinoma
  4. will progress to invasive if not treated in 30-40%
  5. may not form a distinct tumor
  6. may have dilated ducts
  7. microcalcs are common
  8. best diagnosed by mammo
  9. is non-comedo or comedo
A

DCIS

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26
Q

This DCIS is low-grade, slow growing, and less aggressive.

A

non comedo

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27
Q
  1. makes up 40% of all DCIS
  2. carries a 10-fold risk for developing invasive carcinoma
  3. will be cribriform, micropapillary or solid
A

non comedo DCIS

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28
Q

perforated form (sieve-like) non comedo DCIS

A

cribriform

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29
Q

clumpy, along the wall - non comedo DCIS

A

micropapillary

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30
Q

occupies the entire lumen of the duct - non comedo DCIS

A

solid

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31
Q

This DCIS is high-grade, aggressive, and fast growing.

A

comedo

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32
Q
  1. makes up 60% of all DCIS
  2. high risk for developing invasive carcinoma
  3. central necrosis within the tumor (microcalcs)
  4. involves multiple ducts within a segment
  5. larger than non comedo
  6. may have micro-invasion
A

comedo DCIS

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33
Q

This is when cancer cells are found outside the duct with an intact basement membrane.

A

micro-invasion

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34
Q
  1. asymptomatic patient
  2. possible palpable mass
  3. possible nipple discharge
A

clinical features of DCIS

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35
Q
  1. 🎗 mass or no mass
  2. shadowing artifact
  3. architectural distortion
  4. possible duct dilation
  5. 🎗 possible microcalcs
A

sonographic DCIS

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36
Q
  1. mass or no mass
  2. clustered microcalcs
  3. linear, branch pattern of microcalcs
A

mammo DCIS

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37
Q

🎗 This is the most effective imaging method for detecting DCIS (cause microcalcs).

A

mammo

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38
Q
  1. arises from the lobule
  2. affects premenopausal women
  3. tumor growth completely fills the lobule
  4. usually very small
  5. no palpable mass
  6. 🎗 bilateral and multicentric
  7. 10-fold risk of developing invasive carcinoma
  8. not associated with microcalcs
  9. difficult to detect on mammo and soon
  10. may be an incidental finding on biopsy
A

Lobular carcinoma in situ (LCIS)

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39
Q
  1. invasive ductal carcinoma, NOS
  2. invasive lobular carcinoma
  3. medullary carcinoma
  4. colloid (mucinous) carcinoma
  5. tubular carcinoma
  6. papillary carcinoma
A

common types of invasive breast cancer

40
Q
  1. adenoid cystic carcinoma
  2. squamous cell carcinoma
  3. granular cell tumors
  4. angiosarcoma
A

rare forms of invasive breast cancer

41
Q

🎗 This represents malignant changes of the ductal epithelium with invasion through the basement membrane outside the duct

A

Invasive Ductal Carcinoma (IDC)

42
Q

This type of IDC presents the classic hard, gritty texture with an irregular shape and palpable mass.

A

scirrhous

43
Q

🎗 This invasion of surrounding tissue creates a host response or fibrotic reaction.

A

desmoplasia

44
Q

This is the most common type of breast cancer, accounting for 75% of cases.

A

Invasive Ductal Carcinoma (IDC)

45
Q
  1. palpable mass (often larger than imaging appearance)
  2. hard gritty texture
  3. tumor is fixed (immovable)
  4. skin dimpling, skin retraction, or nipple retraction
A

clinical features - Invasive Ductal Carcinoma (IDC)

46
Q
  1. radiopaque density
  2. spiculated, lobulated, irregular margins
  3. microcalcs
  4. thickened and/or retracted cooper’s ligaments
A

mammo - Invasive Ductal Carcinoma (IDC)

47
Q
  1. solid mass
  2. irregular, angular, spiculated
  3. taller-than-wide
  4. markedly hypoechoic
  5. heterogeneous internal appearance
  6. partial or complete posterior shadowing
  7. duct extension or branch pattern
  8. thickened, straightened, or retracted cooper’s ligaments
  9. fascia plane disruption
  10. if early, may have a benign appearance
A

sono - Invasive Ductal Carcinoma (IDC)

48
Q

🎗 This type of tumor offer shadowing from the center of the lesion.

A

scirrhous

49
Q

This represents malignant changes of the lobular epithelium with invasion outside the lobule.

A

Invasive Lobular Carcinoma (ILC)

50
Q

🎗 This is the second most common type of invasive breast cancer, 8-15% of cases.

A

Invasive Lobular Carcinoma (ILC)

51
Q
  1. The most frequently missed breast cancer
  2. usually non palpable
  3. usually no microcalcs
  4. highly infiltrative and aggressive
  5. may produce an area of architectural distortion without a mass
  6. is more likely to be multifocal, -centric, and bilat than IDC
  7. difficult to detect on mammo and sono
A

Invasive Lobular Carcinoma (ILC)

52
Q

T/F? if an ILC mass is present, mammo may be more effective at demonstrating it than soon.

A

FALSE

53
Q

🎗 This accounts for approx 5% of all invasive cancers.

A

Medullary Carcinoma

54
Q

Medullary Carcinoma - age range

A

younger women, (11% of br cancers under 35)

55
Q
  1. well circumscribed, soft tumor
  2. non tender, compressible, slightly movable
  3. non infiltrative
  4. no microcalcs
  5. mistaken for fibroadenoma
  6. common among AA and API
  7. good prognosis
A

Medullary Carcinoma

56
Q
  1. large solid mass
  2. round oval or macrolobulated shape
  3. smooth borders (or microlobulated)
  4. taller-than-wide
  5. hypoechoic
  6. homo or mildly hetero internally
  7. possible enhancement
  8. shadowing is uncommon
  9. poss central necrosis
A

Medullary Carcinoma - sono

57
Q

This is the most commonly mistaken cancer for a benign fibroadenoma

A

Medullary Carcinoma

58
Q

🎗 This accounts for 2 -3 % of all breast cancers

A

Colloid (Mucinous) Carcinoma
also
Tubular Carcinoma

59
Q
  1. slow growing, non aggresive
  2. circumscribed, soft tumor
  3. affects elderly women
  4. good prognosis, mets is uncommon
  5. no microcalcs
A

Colloid (Mucinous) Carcinoma

60
Q
  1. hypo- or isoechoic relative to fat
  2. well circumscribed
  3. microlobulation
  4. homo internally
  5. shadowing uncommon
  6. similar to complicated or complex cyst
A

Colloid (Mucinous) Carcinoma

61
Q

Colloid (Mucinous) Carcinoma - age range

A

elderly

62
Q
  1. relatively small lesion
  2. good pronosis
  3. associated with benign radial scar
  4. may have microcalcs
A

Tubular Carcinoma

63
Q

Mammo demostrates long spicules radiating from a small radiopaque mass

A

Tubular Carcinoma

64
Q
  1. small hypoechoic mass
  2. ill defined margins
  3. posterior shadowing
A

Tubular Carcinoma - sono

65
Q

🎗 This may be non invasive or invasive and represents the malignant version of intraductal papilloma.

A

Papillary Carcinoma

66
Q

Invasive Papillary Carcinoma accounts for __ of all breast cancers.

A

0.3 - 2%

67
Q
  1. primarily affects postmenopausal women
  2. subareolar mass
  3. may have bloody nipple discharge
  4. difficult for imaging to distinguish from benign
A

Papillary Carcinoma

68
Q
  1. well marginated solid mass
  2. may be complex
  3. may have duct dilation
  4. may have microcalcs
  5. if duct is obstructed, may develop cystic apperance
A

Papillary Carcinoma

cystic appearance is Intracystic Papillary Carcinoma

69
Q

Papillary Carcinoma - age range

A

primarily affects postmenopausal women

70
Q

🎗 This disease presents as a crusty scaly appearance of the nipple and areola.

A

Paget’s disease

71
Q
  1. skin thickening of the nipple or areola
  2. poss duct dilatation
  3. poss underlying breast cancer
A

Paget’s disease

72
Q

This occurs due to primary breast cancer invading the lymphatic vessels of the breast.

A

Inflammatory Carcinoma

73
Q

In this condition, the spread of the cancer throughout the lymphatics is rapid and diffuse with poss mets to the opposite breast. The prognosis is poor.

A

Inflammatory Carcinoma

74
Q

Invasive Ductal Carcinoma is the most common primary __

A

Inflammatory Carcinoma

75
Q
  1. causes the breast to become warm, red, swollen, hard, and painful
  2. peau d’orange appearance
  3. flattening or retraction of the nipple
  4. palpable mass
  5. axillary lymph node enlargement
  6. must be differentiated from severe mastitis
A

Inflammatory Carcinoma

76
Q
  1. skin thickening
  2. dilated lymphatic vessels
  3. diffuse appearance of the parenchymal layer
  4. tissue plane disruption
  5. increased doppler in all tissues
  6. poss underlying breast lesion
A

Inflammatory Carcinoma - sono

77
Q

🎗 This refers to 2 or more malignant lesions found within the same ductal system or same quadrant of the breast.

A

Multifocal Carcinoma

78
Q

🎗 This represents 2 or more cancers found within 5 cm.

A

Multifocal Carcinoma

79
Q

🎗 This refers to 2 or more malignant lesions found in separate quadrants of the same breast or found in both breasts.

A

Multicentric Carcinoma

80
Q

🎗 This represents 2 or more cancers found greater than 5 cm distance.

A

Multicentric Carcinoma

81
Q

T/F? Multicentric Carcinoma has a worse prognosis than Multifocal Carcinoma

A

true

82
Q

Male breast cancer accounts for approx __ of all breast cancers.

A

1%

83
Q
  1. usually arises in the subareolar region
  2. commonly DCIS or Invasive Ductal Carcinoma
  3. palpable mass
  4. associated with cryptorchidism, testicular injury, or Klinefelter’s
A

Male Breast Cancer

84
Q

🎗 This is a rare type of lesion arising from the stroma (connective tissue) of the breast. Usually benign, means leaf-like.

A

Phyllodes Tumor, aka cystosarcoma phyllodes

85
Q
  1. can be benign or malignant, a transitional tumor
  2. contain stromal tissue with mucinous, hemorrhagic or cystic fluid
  3. usually solitary
  4. grows rapidly becoming quite large
  5. 🎗 large lobulations present a leaf-like shape
  6. appears as a large, palpable, firm, mobile mass
  7. tends to reoccur
A

Phyllodes Tumor

86
Q

age range - Phyllodes Tumor

A

30-50

87
Q
  1. a form of sarcoma
  2. large multiple lobulations
  3. grows faster than the benign form
  4. central degeneration
  5. spreads to the lung through the bloodstream
  6. treat by lumpectomy or mastectomy
  7. no response to hormones, chemo, or radiation
A

Phyllodes Tumor (malignant)

88
Q
  1. large, solid, well circumscribed mass
  2. smooth lobulated borders
  3. internally iso-or hypoechoic
  4. homogeneous appearance (hetero with necrosis)
  5. poss acoustic enhancement
A

Phyllodes Tumor - sono

89
Q

🎗 This breast condition may be a primary or secondary disease

A

lymphoma

90
Q

Primary lymphoma originates here.

A

The lymph nodes associated with the breast

91
Q

Metastatic lymphoma is [more/less] common than primary lymphoma.

A

more

92
Q
  1. make up less than 1% of breast cancers
  2. usually presents as a palpable breast mass with palpable axillary lymph nodes
  3. cannot be differentiated from other breast cancers on mammo or sono, needs biopsy
A

primary and metastatic lymphoma

93
Q
  1. singular or multiple, solid masses within the breast and /or axilla
  2. hypoechoic
  3. oval-shaped mass indicates a singular lymph node
  4. large lobulated tumors likely represent multiple, fixed lymph nodes
  5. smooth to irregular borders
  6. loss of definition of the fatty hilum of the lymph node
  7. poss acoustic enhancement
A

lymphoma - sono

94
Q

Cancer may metastasize to and from the breast through the __ system, __, or by direct __.

A

lymphatic system, bloodstream, or direct invasion

95
Q

🎗 Primary breast cancer metastasizes to the…

A
  1. lymph nodes
  2. bone
  3. lung
  4. liver
  5. brain
  6. opposite breast
96
Q

🎗 This is the most common location of nodal mets.

A

axillary lymph nodes

97
Q

Tools for evaluating mets?

A
  1. MRI
  2. NM Bone Scan
  3. CXR
  4. PET Scan

Breast Sonography (7 decks)

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