Breast

What is this pathology

Mastitis (inflammation)

What is mastitis and discuss the appearance

Inflammation of the breast during breastfeeding.

Diffuse swelling, skin thickening, increased echogenicity of subcutaneous fat

What are two differential diagnoses for this image

Galactocoele or abscess

What is a way to differentiate a galactocoele from an abscess

Galactocoele - NON TENDER

Abscess - TENDER

What is a Galactocoele

A benign milk filled retention cyst that occurs when a milk duct becomes obstructed

appearance of an abscess and symptoms

A mass with irregular margins, heterogeneous with a mixed cystic/solid areas, posterior enhancement, increased blood flow in walls with no central flow

Skin redness, tender palpable lump, swelling, feeling unwell.

Describe and list this pathology

Dilated ducts with low level echoes (debris) and/or thickened walls

DUCT ECTASIA

What is this pathology

Haematoma

What is this pathology

multiple tiny cysts, can have calcifications

FIBROCYSTIC DISEASE

Difference between duct ectasia and fibrocystic disease

Duct ectasia - widening of milk ducts beneath nipple. No posterior enhancement

Fibrocystic disease - multiple tiny fluid sacs in deeper granular tissue, posterior enhancement

What is sclerosing adenosis

A benign condition where milk-producing glands become enlarged and crowded and have accompanying scar-like fibrosis tissue

Describe appearance of sclerosing adenosis

Irregular hypoechoic mass, poorly defined speculated borders, can exhibit acoustic shadowing. Lacks vascularity

What are two differential diagnoses of this image. But explain what it most likely is and why

1. Sclerosing adenosis

2. Malignancy - carcinoma

Most likely sclerosing adenosis due to lack of vascularity. Carcinomas with most likely have increased vascularity

How to distinguish between sclerosing adenosis vs carcinoma

Sclerosing adenosis can “mimick” cancer - must do a biopsy to confirm.

But upon US appearance a key difference is vascularity - sclerosing adenosis: lack vascularity. Cancer: increased vascularity

simple cyst vs sebaceous cyst

Simple cyst - round anechoic with smooth edges, with posterior enhancement. Usually located deep within granular tissue

Sebaceous cyst - round with internal echoes, posterior enhancement. Located superficially directly within or just under skin of breast

What are these examples of

Sebaceous cyst

Describe the appearance of a fibroadenoma

Round, hypoechoic, circumscribed margins, posterior enhancement, horizontal orientation, can have gross calcifications.

Common in younger women

What is this pathology, describe it

FIBROADENOMA

Well defined hypoechoic mass, posterior enhancement

What is the pathology, and describe

FIBROADENOMA

Well defined hypoechoic mass, posterior enhancement with a gross calcification

Describe and identify

A well defined encapsulated mass within the granular tissue. Solid and Heterogenous echotexture

HAMARTOMA

What is a hamartoma and its clinical presentation

A benign lesion consisting of many types of cells - muscle, fat etc.

Presentation: smooth palpable lump. Typically non tender

Identity the pathology

Intra-Ductal papilloma

Describe and identify

A solid well defined mass within a dilated milk duct.

INTRA-DUCTAL PAPILLOMA

What is an Intra-Ductal papilloma and describe clinical symptoms

A benign tumor in the milk ducts.

Symptoms: bloody/clear nipple discharge, or asymptomatic

Intra-ductal papilloma vs malignancy (ductal carcinoma in situ)

Intraductal papilloma: well defined, uniform, can have macro-calcifications, a single central vascular feeding vessel.

Ductal carcinoma in situ: irregular or spiculated, surrounding distortion/invasion, microcalcifications, disorganised vascularity

Core biopsy to identify for malignancy.

Typical appearance of a breast carcinoma

Hypoechoic, irregular shape and margins, not parallel to skin, echogenic halo, microcalcifications

Typical appearance of a breast carcinoma

Hypoechoic, irregular shape and margins, not parallel to skin, echogenic halo, microcalcifications

What is the potential diagnosis

Infiltrating ductal carcinoma

What is the likely pathology

Ductal carcinoma in situ

DCIS vs IDC

DCIS: starts in lining of milk ducts and is confined to the ducts. Non-invasive.

Appears as if regular calcifications, often with no mass, increased vascularity

IDC: originates from milk ducts but has broken through duct walls and invaded surrounding breast tissue

Appears heterogenous mass with echogenic halo, posterior shadowing and irregular margins. Microcalcifications may be present

Describe appearance of infiltrating lobular carcinoma

Similar appearance to infiltrating ductal carcinoma. Distortion of the mass, less dense posterior shadowing

what is the likely pathology

Papillary carcinoma - solid tissue projecting into a cyst