Unit 4a & 4b: Breast Pathology & BIRADS Flashcards
Irregular is only used to describe ____
SHAPE
(not margins)
Parallel means ___ than ___
Non parallel means ____ than ____
Wider than tall ( think equal sign)
Taller than wide
What is the most common cause of breast lumps in women 35-50 yrs?
CYSTS
What is FCC?
Dilatation of ducts within obstructed TDLUs - most common this way - typically go away on their own - thought to be caused by estrogen increase
Key features of FCC include: FOUR
1) Epithelial hyperplasia
2) Adenosis ( enlarged lobules)
3) Stomal fibrosis
4) Cyst formation
FCC symptoms include: THREE
1) Tenderness/pain/fullness/nodularity
2) Bilateral
3) Nipple discharge
Thin wall, mobile internal echoes/debris, fat fluid level are all signs of a _____ cysts
Complicated
Complex cystic and solid mass that are suspicious contain a ____ wall, ____ septations, ______ mass, and mixed solid and cytic componenets
thick
thick
intracystic
True or false: malignant cysts are common
False
True or False: VAB or vacuum assisted biopsy are most common
True - they want to test the debris
How can you differentiate between an acorn cyst and PAM (papillary apocrine metaplasia) ?
Acorn cyst fat layer will be non-dependent
PAM has a crescent like layer of echogenicity that is non-mobile - associated with FCC
An abnormal change of growth of cells associated with FCC - non-mobile cresent shape - may not aspirate
PAM -papillary apocrine metaplasia
What is the most common BENIGN mass in a lactating patient?
Galactocele
Retention cysts develop from the ___ glands due to blockage
Montgomery
Mastitis is most common during ___
pregnancy and lactation
What is the most common location of an abscess?
Subareolar
Acute thrombophlebitis of superficial veins of breast or chest wall affecting men and women (clot in superficial veins) - SUPERFICIAL CORD LIKE MASS
Mondor Disease
Fat necrosis is caused by _____ - can show dimpling, inversion and skin thickening
trauma
How can you differentiate a scar versus a mass? Think of shadowing
Transducer pressure - if you apply pressure and shadow is reduced it is probably a scar!
Benign characteristics: FOUR
1) Hyperechoic
2) wider than tall
3) Multilobulated ( smoothed and curved)
4) Thin, echogenic capsule
Malignant characteristics: SEVEN
1) spiculation
2) taller than wide
3) angular margins
4) markedly hypoechoic
5) shadowing
6) calcification
7) duct extensions
Low risk nipple discharge : THREE
1) bilateral
2) muliple duct orifices
3) milky greenish
Increased risk of nipple discharge: FIVE
1) Unilateral
2) Spontaneous
3) single duct orificie
4) clear, serous fluid or slight blood
5) associated with skin or nipple changes
What is the most common cause of increased risk nipple discharge ?
Intraductal Papilloma ( not cancerous)
What is the most common benign solid tumour of breast?
Fibroadenoma
(estrogen induces, slow growing)
Secretory adenomas are common in ____patients and are similar to galactocele
Lactating
This tumor is leaf shaped, and appears similar to a fibroadenoma, but has thin clefts of mucinous, hemorrhagic or cystic fluid ( cystic spaces!)
Phylloides Tumor
Also called a “pseudo tumor” and appear isoechoic
Hamartoma
What is the most common Benign Papillary Lesions?
Intraductal (large duct) Papilloma
(little benign polyps in the duct, usually within a major lactiferous duct rather than a TDLU)
What is the #1 cause of spontaneous bloody nipple discharge from a single breast duct?
Intraductal Papilloma
Malignancy of the breast usually develops in the __ __ quadrant and most commonly originates from the ____
Upper Outer
Ducts (TDLU)
Increased risks of malignancy are:
1) age
2) female
3) personal or family hx
4) genetics (BRCA1 and BRCA2 gene mutations)
What does TNM staging stand for?
Tumor
Nodal Status
Mets
Abnormal cells form in the small ducts of the breast lobule and are confined to the boundaries of the duct or lobe is called:
Lobular Carcinoma in Situ (LCIS)
** not actually treated as a true cancer)
What is the most common non-invasive cancer?
Ductal carcinoma in situ (DCIS)
What is the earliest form of cancer that can be detected on imaging?
DCIS
Cancer of the epidermis of the nipple ; redness, ulceration, crusting and discharge of nipple
Paget’s Disease
What is the most common breast cancer?
Invasive Ductal Carcinoma (IDC)
Asymmetric, irregular, radiodense mass with spiculated margins is indicative of:
Invasive ductal carcinoma
The second most common invasive breast cancer is
Invasive Lobular Carcinoma (ILC)
Well marginated/ circumscribed, young women, rapid growing, central necrosis is common
Medullary carcinoma
Colloid carcinoma is also called a ___ carcinoma
Mucinous
Small, slow growing, prominent reactive fibrosis, associated with radial scars
Tubular Carcinoma
Mets from the breast most commonly go to the _________
Axillary Lymph node ( sentinel lobe is a low axillary ln)
bone, liver, lung, brain
Mets to the breast most commonly arise from the
other breast
Melanoma
The most common male breast abnormality is ______ associated with increased estrogen-testosterone ratio
Gynecomastia
(Pseudogynecomastia is caused by obesity)
Strong associated to _____ syndrome and genetics for male breast cancer
Klinefelter
