breast benign lesions

Breast examination (for palpable mass)

• Location of mass

• Clock face or quadrant

• Characteristics of mass

• Size

• Shape (round, oval, lobular, irregular)

• Surface contour (smooth, irregular)

• Consistency (soft, rubbery, firm, hard, gritty)

• Mobility (movable, fixed)

Sonography of a Cyst

Anechoic even with increased

gain

• Smooth, well-defined borders

(even if lobulated, gently

lobulation)

• Through transmission. Structure

did not absorb as much sound as

surrounding tissue.

• Sharply defined posterior wall

Sonography of a Solid Structure

• Echogenic - echoes

with increased gain

• Regular or irregular

borders /margins

• Posterior enhancement or

shadowing

Sonography of a Complex Structure

Both cystic & solid

• Septations

• Low level echoes

• Fluid level

• Through transmission

GENERAL Benign Characteristics

• Smooth or lobulated borders margins

• Displaces surrounding tissues rather than

invade

• Calcifications

• Mild posterior enhancement

• Can display or not display vascularity

GENERAL Malignant Characteristics

• Ill-defined or irregular borders /

margins. Angular margins

• Invade surrounding tissues

• Branching patterns

• Dirty shadowing

• Microcalcifications (punctate)

• Can display or not display

vascularity

• Spiculated

• Taller than wide

• Duct extension

• Thick halo

Surrounding tissue tries to

stop tumor invasion from

progressing. Forms fibrosis

which causes the shadowing.

desmoplastic response

most common pathologic finding

simple cyst

simple cyst forms in

TDLU

simple cyst is due to

obstruction of extralobular terminal duct

simple cyst population

35-50, over 50 if on hot

complicated cysts has blank fluid

intracystic fluid

types of complicated cysts

acorn, snow globe, cluster, filled with thick fluid

acorn has what levels

fluid level, protein level

with complex mass what should you look for

malignant features

reason for sebaceious cyst

obstruction of sebaceous gland or hair follicle

sonography of sebaceous cyst

round, oval well circumscribed. Internal echoes,

through transmission

squamous cells that produce trauma from trauma

epidermal inclusion cysts

happens in women 35-50 as a response to hormones

fibrocystic condition/change

overgrowth of acini in TDLU

adenosis

what may be seen with fibrocystic condition/change

subareolar duct ectasia, hyperechoic coarse apperance with shadowing

Fibrocystic change of

epithelial cells of

acini into

apocrine/sweat

gland type of cells

Apocrine metaplasia

benign breast mass that is solid

fibroadenoma

clinical of fibroadenoma

Firm

Rubbery

Non tender

No fixation

fibroadenoma is higher in blank popluation

african american

sonography of fibroadenoma

• Benign breast mass

• Solid

• Well circumscribed

• Gentle or smooth lobulations

• Displaces surrounding tissue

• Homogenous

• Can have enhancement

• Can be vascular

milk filled cyst

galactocele

galactocele is a potential complication of

infection

proliferation of fatty tissue glandular tissue fibrous tissue

hamartoma/fibroadenoma

sonography of hamartoma

• Smooth margins

• Oval

• Lobulated

• Possible shadowing

• Variable echogenicity

epithelial proferation of duct seen in women 30-55

Intraductal Papilloma

Most common cause of bloody

nipple discharge

Intraductal Papilloma

swiss cheese apperance

juvenile paillomatosis

Multiple small cysts occurring with

proliferative changes in the ductal system in young women

Juvenile Papillomatosis

Thrombosis of superficial

breast veins (subcu fat)

mondors disease

Arise from connective tissue in breast

phyllodes tumor

phyllodes tumor can be what

benign but can be malignant

Inflammation of the breast

Mastitis

clinical of mastitis

Red, swollen, thickened skin

Purulent discharge

Painful axillary nodes

Leukocytosis, fever

sonography of masitis

Skin and parenchymal edema

Prominent lymph channels

Dilated ducts

Increase echogencity of fat

things you can see after trauma

hematoma, seroma, lymphocele, fat necrosis

fremits

tissue vibrations to differenitiate fat lobule and mass

lipoma appears as what on mammo

radiolucent