Breast (Part 2)

Skin layer appears… compared to fat

Hyperechoic

If the shape of a mass does not change upon compression its likely…

Malignant

If the shape of a mass does change upon compression its likely…

Benign

Should a benign mass have flow present on color Doppler?

No

What is a fibrous plane?

1. When a benign mass grows along the tissue plane

2. DOES NOT CROSS IT

What is the most specific feature of malignancy on
mammography and sonography?

Spiculations

Which margins are most sensitive for malignancy?

Angular

Which plane must ducts be scanned in?

Radial

What is desmoplasia?

When a mass has a thick, echogenic halo with fibrotic host response surrounding a breast cancer (walling the cancer off)

What happens to a mass’s size if it has desmoplasia?

May cause the area to feel larger than actual tumor size

What is angiogenesis (neovascularization)?

The ability of a malignancy to develop new blood vessels

Microcalcifications are associated with…

Malignancy

Which category of lesions are hypervascular?

Malignant

What Doppler technique should be used for scanning breast?

1. Low velocity scale

2. Low filter setting

3. Optimal Doppler gain setting

4. Increased PRF for high velocities

Where do breast cysts form?

1. TDLU

2. Obstructed duct

What is frequently found in perimenopausal women and often fluctuates with menstrual cycles?

Breast cyst

A woman comes in to receive an ultrasound. It shows a firm, smooth, mobile, palpable mass that is filled with fluid. What condition does she have?

Breast cyst

When may aspiration be done on a cyst?

1. Painful

2. Abnormal in appearance

3. Abnormal size

A woman comes in to receive a mammogram. It shows a round, radiopaque mass with smooth margins and a peripheral halo. What condition does she have?

Simple cyst

When may the “STAR” mnemonic be used?

To assist in identification of a simple cyst

What does the “STAR” mnemonic stand for?

1. S: smooth and thin-walled

2. T: through transmission

3. A: anechoic

4. R: round or oval

What fluid-filled structures do NOT meet the “STAR” criteria?

Complex cyst

What is an oil cyst?

Benign, liquefaction of injured fat containing oil cells

Galactoceles resolve into… because of their…

1. Oil cysts

2. Fatty milk properties

A woman comes in to receive an ultrasound. It shows a round, anechoic mass with well defined margins and hyperechoic internal echoes. What condition does she have?

Oil cyst

What is a galactocele?

Localized accumulation of milk (milk-filled cyst) caused by obstruction of lactiferous ducts

What condition typically presents as a periareolar/subareolar palpable mass?

Galactocele

A woman presents with a tender breast and a firm, moveable mass. The ultrasound shows a homogenous, well-defined mass with posterior enhancement. What condition does she have?

Galactocele

What is a sebaceous cyst (epidermal inclusion cyst)?

A retention cyst that results from an obstructed
sebaceous gland within dermis

What does a sebaceous cyst contain?

Sebum

A woman comes in to receive an ultrasound. It shows a round, smooth, well-defined, superficial mass with posterior enhancement. What condition does she have?

Sebaceous cyst

What is the “claw sign”?

Hyperechoic dermal tissue that wraps around lesion margin

The “claw sign” is associated with…

Sebaceous cyst

What are fibrocystic changes?

A variety of benign changes in the female breast

What is the most common disorder of the breast?

Fibrocystic changes

What percentage can fibrocystic changes be found in women’s breasts?

60-90%

What are fibrocystic changes caused by?

A battle between proliferation and resorption of epithelial cells and stromal tissues

What are the sub categories of fibrocystic changes? What percentage of women can they be found in?

1. Non-proliferative lesions: 70%

2. Proliferative disorders without atypia: 26%

3. Proliferative disorders: 4%

A woman comes in to receive an ultrasound. It shows multiple cysts resulting from cystic dilatation of TDLU. What condition does she have?

Non-proliferative lesions

A woman comes in to receive an ultrasound. It shows multifocal hyperplasia of both epithelial and connective tissue of the TDLU. What condition does she have?

Proliferative disorders without atypia

A woman comes in to receive an ultrasound. It shows atypical ductal and lobular hyperplasia. What condition does she have?

Proliferative disorders

What condition can be generalized as a cluster of cysts?

Fibrocystic changes

What is the most common solid benign mass in premenopausal women?

Fibroadenoma

Fibroadenomas have an increased incidence in…

African American women

What age are fibroadenomas most common in?

Women of reproductive age (15-35)

What are fibroadenomas stimulated by?

Estrogen

What two tissues are fibroadenomas comprised of?

1. Connective

2. Epithelial

A woman presents with a painless, rubbery, palpable mass. The ultrasound shows an upper quadrant mass with popcorn calcifications. What condition does she have?

Fibroadenoma

Medullary carcinoma may be a differential diagnosis for…

Fibroadenoma

What are the three benign papilloma conditions?

1. Intraducal papilloma

2. Intracystic papilloma

3. Juvenile papillomatosis

What percentage of intraductal papillomas become malignant?

Less than 2%

What is the most common cause of unilateral, spontaneous, bloody nipple discharge?

Intraductal papilloma

What mass may have a “raspberry” appearance?

Intraductal papilloma

What mass may have a “mural” appearance?

Intracystic papilloma

How do you distinguish the difference between an intraductal papilloma and an intracystic papilloma?

1. Intraductal papilloma: tubular ductal dilatation with a solid mass within duct

2. Intracystic papilloma: focal cystic structure with a solid mass within cyst

What condition can be called the “swiss cheese disease”?

Juvenile papillomatosis

A woman comes in to receive an ultrasound. It shows a hypoechoic, heterogenous mass in the periphery of the breast. What condition does she have?

Juvenile papillomatosis

What is the only breast lesion with a true capsule?

Lipoma

A woman presents with a soft, compressible, mobile mass. The ultrasound shows an oval, isoechoic mass with smooth texture. What condition does he have?

Lipoma

What is another name for a fibroadenolipoma?

Hamartoma

What mass is described as a rare, fatty, breast tumor with no capsule?

Fibroadenolipoma

A woman comes in to receive an ultrasound. It shows an oval, well-defined mass that is not encapsulated. What condition does she have?

Fibroadenolipoma

What is described as a rapidly enlarging palpable
mass during pregnancy?

Lactating adenoma

A woman comes in to receive an ultrasound. It shows a large, well-defined mass with lobulated margins and multiple septations. What condition does she have?

Lactating adenoma

What is described as inflammation of the breast?

Mastitis

What are the three types of mastitis?

1. Puerperal: lactational

2. Nonpuerperal: inverted nipple

3. Granulomatous: foreign body, TB, parasitic

A woman presents with a firm, tender, swollen breast with fever and skin discoloration. The ultrasound shows increased echogenicity of subcutaneous fat and parenchymal layers. It also shows blurred tissue planes and increased Doppler flow in the affected area. What condition does she have?

Mastitis

What may be mistaken for mastitis?

Inflammatory carcinoma (1%)

What is described as a localized area of pus that forms within the breast tissue?

Abscess

A woman presents with tender lymph nodes and warm, discolored breasts. The ultrasound shows a complex, cystic mass with irregular borders. It also shows an increased color Doppler signal at the periphery. What condition does she have?

Abscess

What is described as acute thrombophlebitis of the superficial veins of the chest wall and breast?

Mondor’s Disease

What vein is commonly associated with Mondor’s Disease?

Lateral thoracic vein

What are some of the risk factors of Mondor’s Disease?

1. Breast injury/trauma

2. Surgery

3. Pregnancy

4. Infection

5. Cancer

6. Dehydration

A woman presents with a palpable, tender, cord-like superficial mass. The ultrasound shows a superficial, tortuous, tubular lesion with a beaded appearance. Color Doppler shows absent flow in
an obstructed vein nearby. What condition does she have?

Mondor’s Disease

What can be used to resolve phlebitis during Mondor’s Disease?

Hot compress therapy

What are the types of benign traumatic changes?

1. Fat Necrosis

2. Hematoma

3. Seroma

4. Lymphocele

5. Post-Operative Scarring

What is described as the thickening or scarring in the fatty tissue that is commonly procedure-induced?

Fat necrosis

A woman comes in to receive an ultrasound. It shows a firm, fixed, spiculated mass that resembles carcinoma. What condition does she have?

Fat necrosis

What is described as a blood-filled mass that commonly occurs due to trauma or anticoagulants?

Hematoma

A woman presents with a painful, palpable mass and skin bruising. The ultrasound shows a complex mass with thick walls and layering debris. What condition does she have?

Chronic (old) hematoma

A woman presents with a painful, palpable mass and skin bruising. The ultrasound shows an anechoic and well-marginated mass. What condition does she have?

Acute (new) hematoma

What is a seroma?

Localized collection of serous fluid in breast

A woman comes in to receive an ultrasound. It shows a fluid-filled structure with angular margins, thick walls, and septations. What condition does she have?

Seroma

What is a lymphocele?

A cystic tumor filled with lymph fluid

A woman comes in to receive an ultrasound. It shows a thin shadow from the skin surface with a spiculated, fixed, hypoechoic mass. What condition does she have?

Lymphocele

What can be characterized as a benign enlargement of a breast lobule due to epithelial and stromal hyperplasia?

Sclerosing adenosis

A woman comes in to receive an ultrasound. It shows an irregular, hypoechoic mass. What condition does she have?

Sclerosing adenosis

What is a radial scar?

Invasion of ductal epithelium into surrounding stromal tissues

What percentage of cases is radial scarring associated with tubular carcinoma?

20%

A woman comes in to receive an ultrasound. It shows an irregular, spiculated lesion. What condition does she have?

Radial scarring

Which breast quadrant is cancer commonly found in?

Upper outer quadrant

What is the developmental progression of breast cancer?

1. Normal epithelium

2. Hyperplasia

3. DCIS

4. Invasive cancer

5. Metastasis

What does multicentric mean?

When two cancers are found more than 5 cm apart (different quadrants)

What does multifocal mean?

When two lesions involving a single breast cancer are found in same quadrant of same breast

… is a rare indicator of breast cancer

Pain

What are the risk factors for developing breast cancer?

1. Gender

2. Age

3. Family history

4. Personal history of breast cancer

5. Menstrual periods

6. Nulliparity

7. Hormonal influence

8. Personal history of cancer

9. Radiation therapy

10. Obesity

What is the strongest risk factor for developing breast cancer?

Gender: Women are 100 times more likely to develop breast cancer than men

What is the second strongest risk factor for developing breast cancer?

Age

What is the third strongest risk factor for developing breast cancer?

Family history: Having a first degree relative with breast cancer doubles the risk

Most cancers arise from the…

TDLU