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Breast US > Malignant Lesions > Flashcards

Malignant Lesions Flashcards

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1
Q

What’s the most common breast cancer being diagnosed today?

A

Ductal carcinoma in situ (20%)

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2
Q

Is DCIS easily detectable?

A

Not really- not palpable, typically asymptomatic. It’s usually detected by the presence of microcalcs on mammogram

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3
Q

DCIS contains the ducts and surrounding tissue.

A

False – only contained in the ducts

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4
Q

What is comedo DCIS

A

The most aggressive grade and highest risk

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5
Q

If high grade DCIS is found, what’s the treatment typically?

A

Mastectomy and radiotherapy

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6
Q

Is DCIS a true cancer?

A

Yes, LCIS is not. Many clinicians prefer the term lobular neoplasia as this is just considered a marker for increased risk of breast carcinoma.

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7
Q

How is LCIS discovered?

A

Incidentally discovered during procedures such as biopsies. Displays no mammographic or ultrasound abnormalities.

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8
Q

What’s the current treatment for LCIS?

A

Mammo routine screenings every 6 mo. Treatment used to be bilateral mastectomy

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9
Q

Invasive Ductal Carcinoma NOS

A

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.

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10
Q

What invasive breast lesion makes up 65-75% of all invasive mammary carcinomas?

A

Invasive ductal carcinoma

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11
Q

Which group of breast cancers has the worst prognosis of invasive carcinomas?

A

NOS group

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12
Q

Who is more likely affected by medullary carcinoma?

A

Black and Japanese patients. Also the younger patients, rarely the old

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13
Q

How does medullary carcinoma present itself?

A

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.

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14
Q

Sono appearance of mucinous carcinoma

A

Somewhat circumscribed w posterior acoustic enhancement, and can range from hypoechoic to hyperechoic.

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15
Q

Pure mucinous carcinomas have a ____ prognosis

A

good

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16
Q

What is common with tubular carcinoma and important for the sonographer to assess?

A

Multifocal disease and satellite lesions

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17
Q

Most common symptom of papillary carcinoma?

A

Bloody nipple discharge

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18
Q

Where are most papillary carcinoma’s found?

A

Subareolar region

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19
Q

Subareolar papillary carcinomas are usually ______ and have what appearance? Papillary carcinoma’s in the periphery are _______ and have what appearance?

A

Solitary, complex cystic.

Multiple, solid

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20
Q

Paget’s Disease of the Nipple originates as:

A

DCIS – 95% of pts with PDoN also have DCIS

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21
Q

Signs and symptoms of Paget’s disease of the nipple?

A

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.

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22
Q

What’s the second most common type of invasive tumor?

A

Invasive Lobular Carcinoma

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23
Q

ILC presents histologically as cells infiltrating in a:

A

uniform, linear arrangement

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24
Q

What’s the sono appearance of ILC?

A

Typical characteristics of other malignant lesions, except no development of microcalcifications

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25
Q

Which malignant invasive carcinoma is more likely to be missed on a mammogram?

A

Invasive lobular carcinoma because of it’s linear configuration

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26
Q

Metaplastic carcinoma contains what type of tissue?

A

Glandular and non glandular

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27
Q

Does inflammatory breast cancer have a good prognosis?

A

No, as it usually grows and spreads rapidly. Most patients die within 2 yrs of diagnosis.

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28
Q

Inflammatory breast cancer presents symptoms similar to ?

A

Mastitis. Firmness, swelling, tenderness, burning, erythema, peau d’orange or other skin changes, and axillary LN involvement

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29
Q

Sono appearance of inflammatory breast carcinoma:

A

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

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30
Q

What are features that make Phyllodes tumors more likely to be malignant?

A

Size greater than 3cm, mixed echotexture with cystic spaces and presents in older patients

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31
Q

Malignant Phyllodes tumors easily spread to the lymph nodes.

A

False, rarely metastasizes to the axilla. It is more prone to hematogenous spread to the lungs, liver and other distant locations…. fatal

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32
Q

Multifocal vs multicentric breast lesions:

A

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

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33
Q

Which form of primary lymphoma of the breast is more common?

A

Burkitt’s type – found in pregnant/lactating women and carries an extremely poor prognosis

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34
Q

BIA-ALCL (breast implant associated anaplastic large cell lymphoma):

A

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

35
Q

The most common metastatic lesion of the breast is

A

lymph node involvement to the contralateral breast

36
Q

Metastatic breast cancer or

A

Stage 4 breast cancer

37
Q

The most common regions (4) that breast cancer spreads:

A

contralateral breast
bone
lung
liver

38
Q

In males, the most common primary cancer to metastasize to the breast is

A

prostate

39
Q

Non mammary, or extramammary metastases to the female breast can come from:

A

malignant melanoma (mc)
lung
cervix
bladder, lymphoma, ovarian

40
Q

Where are metastatic tumor cells usually deposited?

A

superficial fat layer via the blood stream

41
Q

Are metastatic lesions fast or slow growing

A

Fast

42
Q

Do you seen a desmoplastic reaction with metastatic lesions?

A

No, due to the rapid growth

43
Q

Whats the 5 year recurrence rate after 5 yrs of a lumpectomy?

A

4.2%

44
Q

What are secondary primaries?

A

breast occurrence that typically occurs at or close to the original site

45
Q

What’s the recurrence rate on women with a mastectomy?

A

1% unilateral, 1.5% bilateral

46
Q

Where’s the most common area of breast carcinoma seen in men?

A

Subareolar or retroareolar

47
Q

Where’s the second most common area of breast carcinoma seen in men?

A

OUQ

48
Q

Where’s the most common location for carcinoma seen in women? Second most common?

A

OUQ

Then retroareolar, IOQ, LOQ, LIQ and lastly multifocal

49
Q

Breast tissue during pregnancy appears more:

A

hypoechoic
more prominent ducts
(lactating parenchyma is more echogenic)

50
Q

Most common benign lesion in breast feeding women?

A

Galactocele

51
Q

Galactoceles can last for _____ and turn into a ___________.

A

Years, oil cyst

52
Q

What’s a distinguishing feature of a galactocele?

A

They always have posterior acoustic enhancement

53
Q

Can ultrasound confirm the diagnosis of an oil cyst?

A

No, the cyst would have to be aspirated and you would see milky fluid

54
Q

A galactocele can present as a (3)?

A

pseudolipoma, pseudohamartoma, pseudoadenoma

55
Q

What’s the most common benign solid lesion of pregnancy and lactation?

A

FA

56
Q

Pregnancy Associated Breast Carcinoma (PABC)

A

breast cancer diagnosis made during pregnancy or within the first postpartum years

57
Q

Supernumerary breast tissue more often occurs on which side of the body?

A

Left

58
Q

What’s the most common form of supernumerary breast tissue? Second most common?

A

Polythelia (2+nipples)

Polymastia – most common site is axilla

59
Q

What’s the most common form of undevelopment of the breast tissue?

A

Hypoplasia

60
Q

Amazia

A

Breast tissue is absent, but nipple is present

61
Q

What’s virginal hypertrophy?

A

excessive growth of the breasts at the onset of puberty

caused by the over sensitivity to prolactin, estrogen and progesterone

62
Q

Precocious puberty:

A

8 yrs female, 9yrs males

63
Q

What’s the difference between precocious puberty and pseudoprecocious puberty?

A

True - secondary sexual characteristics as well as enlargement and activity in the gonads
Pseudo - secondary characteristics, but the gonads do not mature

64
Q

BIRADS 0

A

inconclusive

65
Q

BIRADS 1

A

negative

66
Q

BIRADS 2

A

benign

67
Q

BIRADS 3

A

probably benign

68
Q

BIRADS 4 A

A

low suspicion for malignancy

69
Q

BIRADS 4 B

A

moderate suspicion for malignancy

70
Q

BIRADS 4 C

A

high suspicion for malignancy

71
Q

BIRADS 5

A

highly suggestive of malignancy

72
Q

BIRADS 6

A

Known biopsy proven malignancy

73
Q

Which of the following invasive breast cancers has an excellent prognosis with lymph node involvement being uncommon?

A

Adenoid cystic carcinoma

74
Q

Indicate thee receptor type associated with the lowest recurrence rate after 5 yrs in patients who had lumpectomies.

A

Triple positive breast cancer

75
Q

Indicate thee receptor type associated with the highest recurrence rate after 5 yrs in patients who had lumpectomies.

A

Triple negative breast cancer

76
Q

LCIS is more commonly identified in ___________ women. Does it occur bilaterally or unilaterally?

A

Premenopausal women

Bilaterally with multiple foci

77
Q

Does LCIS display any mammographic or ultrasonic abnormalities?

A

No

78
Q

Up to _____% of the patients with LCIS develop breast cancer over a course of 15-20yrs, ____% of them in the _________ breast

A

30
50
contralateral

79
Q

What are the 5 invasive breast cancers?

A 
Invasive ductal carcinoma NOS
Medullary carcinoma
Mucinous (or colloid) carcinoma
Tubular carcinoma
Papillary carcinoma
80
Q

Mucinous carcinomas often display prominent

A

Posterior acoustic enhancement

81
Q

Tubular carcinoma:

A

rare form. Usually occurs between 44-49yrs of age
associated w foci of DCIS
Mostly diagnosed on mammo

82
Q

How does tubular carcinoma appear on ultrasound?

A

small, vertical oriented mass w posterior shadowing and spiculated/angular margins

83
Q

Are papillary carcinoma’s slow or fast growing?

A

slow

84
Q

Is Paget’s disease of the nipple rare or common?

A

Rare

Breast US (6 decks)

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