Misc

Question 1

What clinical history most likely accounts for the imaging findings shown?

Answer 1

Bilateral reduction mammoplasty

Question 2

Answer 2

Breast Hamartoma.

“Breast within a breast”, or “sausage appearance”

association: cowden syndrome

Question 3

Answer 3

Question 4

Answer 4

Inflamed cyst

MR: T2-hyperintense, oval or round mass; slow, persistent, uniformly thin rim (not nodular or irregular) enhancement

Question 5

Answer 5

mucinous carcinoma/colloid carcinoma

-subtype of IDC

MR: Characteristic high-signal T2/STIR due to high mucin content; avid, slow rim enhancement

Question 6

Six months between exams. Likely diagnosis?

Answer 6

Phyllodes tumor

Question 7

Answer 7

Paget disease of the left breast. Left areolar thickening.

Paget is DCIS of the nipple. Stage 0

Question 8

True or false, discharge associated with breast cancer usually arises from a single duct

Answer 8

true.

Benign nipple discharge usually arises from multiple ducts, whereas nipple
discharge from a papilloma or DCIS usually occurs from a single duct.

Question 10

Most common mass producing bloody nipple discharge:

Answer 10

benign intraductal papilloma

Question 11

When is nipple discharge concerning?

Answer 11

Nipple discharge is of particular concern if it is spontaneous and from a
single duct, or if the discharge is clear or bloody.

Question 12

Which of the following risk factors places a patient at highest risk for developing breast cancer?

A. Moderate/florid ductal hyperplasia

B. Lobular carcinoma in situ

C. Sclerosing adenosis

D. Atypical ductal hyperplasia

Answer 12

B. Lobular carcinoma in situ.

High risk for breast cancer with lobular carcinoma insitu( 8-10X
increase)

Ductal hyperplasia, sclerosing adenosis and typical ductal hyperplasia have a moderate increased risk

Question 13

What percentage of breast cancers occur in men?

Answer 13

1%

Question 14

mean age of presentation of phyllodes

Answer 14

40 -50 years old. Phyllodes tumors typically occur 10-20 years later than
fibroadenomas

Question 16

if you see an MRI finding on MRI for the extent of the disease and see a new lesion, next step?

Answer 16

go to mammo or US and look for the lesion there and then biopsy it using either of those modalities

Question 17

if you get a benign path result for a BI-RADS cat 5 lesion, what is the next step?

Answer 17

surgical excision. BI RADS 5 means you are really sure it is cancer despite the path results and it should be taken out

Question 18

surgically excise what lesions?

Answer 18

DCIS, LCIS, anything with atypia in the name

Question 19

Answer 19

NF1

NF-1 in an 80-yearold woman with multiple superficial neurofibromas over her torso. Right and left MLO mammograms (a) and left craniocaudal mammogram (b) show numerous dense, circumscribed ovoid masses surrounded by lucent halos of air in the axillae (arrowheads in a) and breasts (arrows in b), findings that represent cutaneous neurofibromas.

https://pubs.rsna.org/doi/pdf/10.1148/rg.314105205

Question 20

Answer 20

Mixed connective tissue disease characterized by limited systemic sclerosis, severe Raynaud phenomenon, and dermatomyositis in a 37-year-old woman.

Question 21

Answer 21

complicated cyst

30% chance of malignancy

BUT…in this case on mammo there was egg shell/rim calcifications. So this was a case of fat necrosis which can mimic malignancy

Question 22

how thick does the breast has to be for stereotactic biopsy?

Answer 22

3 cm thickness (minimum)

Question 23

how deep does the lesion have to be for a stereotactic biopsy?

Answer 23

at least 1 cm

Question 24

male with breast tenderness

Answer 24

gynecomastia

Question 25

Answer 25

NF1

Question 26

breast feeding woman with new palp

Answer 26

lactating adenoma

notice the internal vascularity. in contrast, a galactocele will not have internal flow

Question 27

next step for breast abscess

Answer 27

aspiration and antibiotics

Question 28

bi-rads for an abscess

Answer 28

bi-rads 2

Question 29

what is a granular cell tumor

Answer 29

rare tumor of neural origin

typically benign

in pre-menopausal women

when deep may adhere to pectoralis fascia (commonly seen in the retroglandular fat)

Question 30

if there are suspicious calcs ans associated increased density, what is the next step?

Answer 30

go to ultrasound to look for the invasive mass lesion –> US biopsy

calcs in the duct are typically not invasive (confined to the duct)

Question 31

what are the predominant type of xrays generated in mammography?

Answer 31

characteristic radiation

Answer 32

US of intracapsular rupture (step ladder sign)

Question 33

Answer 33

normal US appearance of an implant

Question 34

what factors cause decreased breast density?

Answer 34

vitamin D and calcium intake, Danazol, age, weight gain