Unit 4a & 4b: Breast Pathology & BIRADS

Question 1

Irregular is only used to describe ____

Answer 1

SHAPE
(not margins)

Question 2

Parallel means ___ than ___
Non parallel means ____ than ____

Answer 2

Wider than tall ( think equal sign)
Taller than wide

Question 3

What is the most common cause of breast lumps in women 35-50 yrs?

Answer 3

CYSTS

Question 4

What is FCC?

Answer 4

Dilatation of ducts within obstructed TDLUs - most common this way - typically go away on their own - thought to be caused by estrogen increase

Question 5

Key features of FCC include: FOUR

Answer 5

1) Epithelial hyperplasia
2) Adenosis ( enlarged lobules)
3) Stomal fibrosis
4) Cyst formation

Question 6

FCC symptoms include: THREE

Answer 6

1) Tenderness/pain/fullness/nodularity
2) Bilateral
3) Nipple discharge

Question 7

Thin wall, mobile internal echoes/debris, fat fluid level are all signs of a _____ cysts

Answer 7

Complicated

Question 8

Complex cystic and solid mass that are suspicious contain a ____ wall, ____ septations, ______ mass, and mixed solid and cytic componenets

Answer 8

thick
thick
intracystic

Question 9

True or false: malignant cysts are common

Answer 9

False

Question 10

True or False: VAB or vacuum assisted biopsy are most common

Answer 10

True - they want to test the debris

Question 11

How can you differentiate between an acorn cyst and PAM (papillary apocrine metaplasia) ?

Answer 11

Acorn cyst fat layer will be non-dependent
PAM has a crescent like layer of echogenicity that is non-mobile - associated with FCC

Question 12

An abnormal change of growth of cells associated with FCC - non-mobile cresent shape - may not aspirate

Answer 12

PAM -papillary apocrine metaplasia

Question 13

What is the most common BENIGN mass in a lactating patient?

Answer 13

Galactocele

Question 14

Retention cysts develop from the ___ glands due to blockage

Answer 14

Montgomery

Question 15

Mastitis is most common during ___

Answer 15

pregnancy and lactation

Question 16

What is the most common location of an abscess?

Answer 16

Subareolar

Question 17

Acute thrombophlebitis of superficial veins of breast or chest wall affecting men and women (clot in superficial veins) - SUPERFICIAL CORD LIKE MASS

Answer 17

Mondor Disease

Question 18

Fat necrosis is caused by _____ - can show dimpling, inversion and skin thickening

Answer 18

trauma

Question 19

How can you differentiate a scar versus a mass? Think of shadowing

Answer 19

Transducer pressure - if you apply pressure and shadow is reduced it is probably a scar!

Question 20

Benign characteristics: FOUR

Answer 20

1) Hyperechoic
2) wider than tall
3) Multilobulated ( smoothed and curved)
4) Thin, echogenic capsule

Question 21

Malignant characteristics: SEVEN

Answer 21

1) spiculation
2) taller than wide
3) angular margins
4) markedly hypoechoic
5) shadowing
6) calcification
7) duct extensions

Question 22

Low risk nipple discharge : THREE

Answer 22

1) bilateral
2) muliple duct orifices
3) milky greenish

Question 23

Increased risk of nipple discharge: FIVE

Answer 23

1) Unilateral
2) Spontaneous
3) single duct orificie
4) clear, serous fluid or slight blood
5) associated with skin or nipple changes

Question 24

What is the most common cause of increased risk nipple discharge ?

Answer 24

Intraductal Papilloma ( not cancerous)

Question 25

What is the most common benign solid tumour of breast?

Answer 25

Fibroadenoma (estrogen induces, slow growing)

Question 26

Secretory adenomas are common in ____patients and are similar to galactocele

Answer 26

Lactating

Question 27

This tumor is leaf shaped, and appears similar to a fibroadenoma, but has thin clefts of mucinous, hemorrhagic or cystic fluid ( cystic spaces!)

Answer 27

Phylloides Tumor

Question 28

Also called a "pseudo tumor" and appear isoechoic

Answer 28

Hamartoma

Question 29

What is the most common Benign Papillary Lesions?

Answer 29

Intraductal (large duct) Papilloma (little benign polyps in the duct, usually within a major lactiferous duct rather than a TDLU)

Question 30

What is the #1 cause of spontaneous bloody nipple discharge from a single breast duct?

Answer 30

Intraductal Papilloma

Question 31

Malignancy of the breast usually develops in the __ __ quadrant and most commonly originates from the ____

Answer 31

Upper Outer Ducts (TDLU)

Question 32

Increased risks of malignancy are:

Answer 32

1) age 2) female 3) personal or family hx 4) genetics (BRCA1 and BRCA2 gene mutations)

Question 33

What does TNM staging stand for?

Answer 33

Tumor Nodal Status Mets

Question 34

Abnormal cells form in the small ducts of the breast lobule and are confined to the boundaries of the duct or lobe is called:

Answer 34

Lobular Carcinoma in Situ (LCIS) ** not actually treated as a true cancer)

Question 35

What is the most common non-invasive cancer?

Answer 35

Ductal carcinoma in situ (DCIS)

Question 36

What is the earliest form of cancer that can be detected on imaging?

Answer 36

DCIS

Question 37

Cancer of the epidermis of the nipple ; redness, ulceration, crusting and discharge of nipple

Answer 37

Paget's Disease

Question 38

What is the most common breast cancer?

Answer 38

Invasive Ductal Carcinoma (IDC)

Question 39

Asymmetric, irregular, radiodense mass with spiculated margins is indicative of:

Answer 39

Invasive ductal carcinoma

Question 40

The second most common invasive breast cancer is

Answer 40

Invasive Lobular Carcinoma (ILC)

Question 41

Well marginated/ circumscribed, young women, rapid growing, central necrosis is common

Answer 41

Medullary carcinoma

Question 42

Colloid carcinoma is also called a ___ carcinoma

Answer 42

Mucinous

Question 43

Small, slow growing, prominent reactive fibrosis, associated with radial scars

Answer 43

Tubular Carcinoma

Question 44

Mets from the breast most commonly go to the _________

Answer 44

Axillary Lymph node ( sentinel lobe is a low axillary ln) bone, liver, lung, brain

Question 45

Mets to the breast most commonly arise from the

Answer 45

other breast Melanoma

Question 46

The most common male breast abnormality is ______ associated with increased estrogen-testosterone ratio

Answer 46

Gynecomastia (Pseudogynecomastia is caused by obesity)

Question 47

Strong associated to _____ syndrome and genetics for male breast cancer

Answer 47

Klinefelter