Malignant Lesions Flashcards
What’s the most common breast cancer being diagnosed today?
Ductal carcinoma in situ (20%)
Is DCIS easily detectable?
Not really- not palpable, typically asymptomatic. It’s usually detected by the presence of microcalcs on mammogram
DCIS contains the ducts and surrounding tissue.
False – only contained in the ducts
What is comedo DCIS
The most aggressive grade and highest risk
If high grade DCIS is found, what’s the treatment typically?
Mastectomy and radiotherapy
Is DCIS a true cancer?
Yes, LCIS is not. Many clinicians prefer the term lobular neoplasia as this is just considered a marker for increased risk of breast carcinoma.
How is LCIS discovered?
Incidentally discovered during procedures such as biopsies. Displays no mammographic or ultrasound abnormalities.
What’s the current treatment for LCIS?
Mammo routine screenings every 6 mo. Treatment used to be bilateral mastectomy
Invasive Ductal Carcinoma NOS
More common in older women. Present with a hard, palpable lump, often with focal tenderness and nipple discharge/inversion. If it’s advanced, one may have skin invasion, retraction and/or ulceration.
What invasive breast lesion makes up 65-75% of all invasive mammary carcinomas?
Invasive ductal carcinoma
Which group of breast cancers has the worst prognosis of invasive carcinomas?
NOS group
Who is more likely affected by medullary carcinoma?
Black and Japanese patients. Also the younger patients, rarely the old
How does medullary carcinoma present itself?
Soft, mobile, fleshy, circumscribed tumor w smooth, non-infiltrating borders. It may be confused with a fibroadenoma, but these tumors grow very quickly and have a more favorable prognosis than IDC-NOS.
Sono appearance of mucinous carcinoma
Somewhat circumscribed w posterior acoustic enhancement, and can range from hypoechoic to hyperechoic.
Pure mucinous carcinomas have a ____ prognosis
good
What is common with tubular carcinoma and important for the sonographer to assess?
Multifocal disease and satellite lesions
Most common symptom of papillary carcinoma?
Bloody nipple discharge
Where are most papillary carcinoma’s found?
Subareolar region
Subareolar papillary carcinomas are usually ______ and have what appearance? Papillary carcinoma’s in the periphery are _______ and have what appearance?
Solitary, complex cystic.
Multiple, solid
Paget’s Disease of the Nipple originates as:
DCIS – 95% of pts with PDoN also have DCIS
Signs and symptoms of Paget’s disease of the nipple?
Pain and itching of nipple, as well as scaling and erythema of the nipple itself. As the disease progress, the nipple becomes crusty with a bloody discharge and may also become inverted.
What’s the second most common type of invasive tumor?
Invasive Lobular Carcinoma
ILC presents histologically as cells infiltrating in a:
uniform, linear arrangement
What’s the sono appearance of ILC?
Typical characteristics of other malignant lesions, except no development of microcalcifications
Which malignant invasive carcinoma is more likely to be missed on a mammogram?
Invasive lobular carcinoma because of it’s linear configuration
Metaplastic carcinoma contains what type of tissue?
Glandular and non glandular
Does inflammatory breast cancer have a good prognosis?
No, as it usually grows and spreads rapidly. Most patients die within 2 yrs of diagnosis.
Inflammatory breast cancer presents symptoms similar to ?
Mastitis. Firmness, swelling, tenderness, burning, erythema, peau d’orange or other skin changes, and axillary LN involvement
Sono appearance of inflammatory breast carcinoma:
mass or masses with irregular, indistinct borders, or as a diffuse increase in tissue echogenicity and disruption of normal tissue planes. Dilated lymphatics or interstitial fluid is often visible, along with calcifications
What are features that make Phyllodes tumors more likely to be malignant?
Size greater than 3cm, mixed echotexture with cystic spaces and presents in older patients
Malignant Phyllodes tumors easily spread to the lymph nodes.
False, rarely metastasizes to the axilla. It is more prone to hematogenous spread to the lungs, liver and other distant locations…. fatal
Multifocal vs multicentric breast lesions:
more than one breast tumor being present, but in the same section of the breast, originating from the original tumor
multicentric- more than one tumor, and they’re all formed separately and are in different areas of the breast
Which form of primary lymphoma of the breast is more common?
Burkitt’s type – found in pregnant/lactating women and carries an extremely poor prognosis
BIA-ALCL (breast implant associated anaplastic large cell lymphoma):
lymphoma linked to breast implants. T-cell lymphoma that is associated with textured, rather than smooth surfaced implants. Identified in patients undergoing implant revision for persistent seroma
The most common metastatic lesion of the breast is
lymph node involvement to the contralateral breast
Metastatic breast cancer or
Stage 4 breast cancer
The most common regions (4) that breast cancer spreads:
contralateral breast
bone
lung
liver
In males, the most common primary cancer to metastasize to the breast is
prostate
Non mammary, or extramammary metastases to the female breast can come from:
malignant melanoma (mc)
lung
cervix
bladder, lymphoma, ovarian
Where are metastatic tumor cells usually deposited?
superficial fat layer via the blood stream
Are metastatic lesions fast or slow growing
Fast
Do you seen a desmoplastic reaction with metastatic lesions?
No, due to the rapid growth
Whats the 5 year recurrence rate after 5 yrs of a lumpectomy?
4.2%
What are secondary primaries?
breast occurrence that typically occurs at or close to the original site
What’s the recurrence rate on women with a mastectomy?
1% unilateral, 1.5% bilateral
Where’s the most common area of breast carcinoma seen in men?
Subareolar or retroareolar
Where’s the second most common area of breast carcinoma seen in men?
OUQ
Where’s the most common location for carcinoma seen in women? Second most common?
OUQ
Then retroareolar, IOQ, LOQ, LIQ and lastly multifocal
Breast tissue during pregnancy appears more:
hypoechoic
more prominent ducts
(lactating parenchyma is more echogenic)
Most common benign lesion in breast feeding women?
Galactocele
Galactoceles can last for _____ and turn into a ___________.
Years, oil cyst
What’s a distinguishing feature of a galactocele?
They always have posterior acoustic enhancement
Can ultrasound confirm the diagnosis of an oil cyst?
No, the cyst would have to be aspirated and you would see milky fluid
A galactocele can present as a (3)?
pseudolipoma, pseudohamartoma, pseudoadenoma
What’s the most common benign solid lesion of pregnancy and lactation?
FA
Pregnancy Associated Breast Carcinoma (PABC)
breast cancer diagnosis made during pregnancy or within the first postpartum years
Supernumerary breast tissue more often occurs on which side of the body?
Left
What’s the most common form of supernumerary breast tissue? Second most common?
Polythelia (2+nipples)
Polymastia – most common site is axilla
What’s the most common form of undevelopment of the breast tissue?
Hypoplasia
Amazia
Breast tissue is absent, but nipple is present
What’s virginal hypertrophy?
excessive growth of the breasts at the onset of puberty
caused by the over sensitivity to prolactin, estrogen and progesterone
Precocious puberty:
8 yrs female, 9yrs males
What’s the difference between precocious puberty and pseudoprecocious puberty?
True - secondary sexual characteristics as well as enlargement and activity in the gonads
Pseudo - secondary characteristics, but the gonads do not mature
BIRADS 0
inconclusive
BIRADS 1
negative
BIRADS 2
benign
BIRADS 3
probably benign
BIRADS 4 A
low suspicion for malignancy
BIRADS 4 B
moderate suspicion for malignancy
BIRADS 4 C
high suspicion for malignancy
BIRADS 5
highly suggestive of malignancy
BIRADS 6
Known biopsy proven malignancy
Which of the following invasive breast cancers has an excellent prognosis with lymph node involvement being uncommon?
Adenoid cystic carcinoma
Indicate thee receptor type associated with the lowest recurrence rate after 5 yrs in patients who had lumpectomies.
Triple positive breast cancer
Indicate thee receptor type associated with the highest recurrence rate after 5 yrs in patients who had lumpectomies.
Triple negative breast cancer
LCIS is more commonly identified in ___________ women. Does it occur bilaterally or unilaterally?
Premenopausal women
Bilaterally with multiple foci
Does LCIS display any mammographic or ultrasonic abnormalities?
No
Up to _____% of the patients with LCIS develop breast cancer over a course of 15-20yrs, ____% of them in the _________ breast
30
50
contralateral
What are the 5 invasive breast cancers?
Invasive ductal carcinoma NOS Medullary carcinoma Mucinous (or colloid) carcinoma Tubular carcinoma Papillary carcinoma
Mucinous carcinomas often display prominent
Posterior acoustic enhancement
Tubular carcinoma:
rare form. Usually occurs between 44-49yrs of age
associated w foci of DCIS
Mostly diagnosed on mammo
How does tubular carcinoma appear on ultrasound?
small, vertical oriented mass w posterior shadowing and spiculated/angular margins
Are papillary carcinoma’s slow or fast growing?
slow
Is Paget’s disease of the nipple rare or common?
Rare
