Breast

Mondor disease

Superficial thrombophlebitis Just under the skin Clinically visible Should distinguish from dilated ducts with intraduct content Vein cannot be compressed due to thrombosis Often not detected on mammogram

Sternalis muscle

Rare variant Triangular or round in shape Seen medially adjacent to sternum Look for it in the CC view of mammogram Knowledge of this is imperative to rule out a mass

Poland syndrome

Varying degress of hypoplasia or even absence of Costosternal component of pectoralis major Serratus anterior External oblique Costal cartilages May be associated with syndactyly, other upper limb deformities Ipsilateral breast maybe hypoplastic or absent

Polythelia, polymastia

Polythelia: accessory nipples Polymastia: accessory breasts

Levels of axillary lymph nodes

Level I Inferior and lateral to pectoralis minor Level II Rotter nodes – beneath pectoralis minor Level III Superior to pectoralis minor Level I and II usually removed in full dissection

Paget disease of the nipple

Carcinoma in situ from nipple epidermis Nipple areola thickening and retraction No obvious findings in ultrasound Abnormal nipple enhancement in post Gd MRI

Ductal carcinoma in situ

Malignancy from epithelial cells of terminal duct lobular unit No basement membrane invasion Calcification is the most common finding – fine linear or branching, tend to be a cluster seen accompanying dilated ducts which have indistinct walls. Associated mass suggests invasion

Phyllodes tumor

Can be benign or malignant Arises from periductal stroma The papillary growth pattern is the origin of the name ‘Phyllodes’ (leaf-like in Greek) Large rapidly growing without calcifications. Calcifications when present (rare) are large and chunky Difficult do distinguish from a highly cellular fibroadenoma The clefts in the papillary growth appear as cystic spaces onContinue reading “Phyllodes tumor”

Fibromatosis of breast

Aggressive growth of fibroblasts and myofibroblasts Arises typically from pectoralis fascia Hence the mass is often seen closely related to pectoralis major Large spiculated dense lesion Hypoechoic on ultrasound, hypointense on MR sequences with variable enhancement post contrast MRI best for delineating extent prior to excision

Pseudoangiomatous stromal hyperplasia (PASH)

Benign lesion Myofibroblastic hyperplasia Round or oval shaped 5-10 cm sized well defined lesion Very slow growing No typical echogenicity or enhancement patterns Core biopsy diagnostic

Papilloma breast

Benign proliferation of duct epithelial and myoepithelial cells 70% lesions central, involves main ducts in subareolar region 30% occurs in peripheral breast, in terminal duct lobular units Lesion is occult usually in mammography Ultrasound and galactography are high yielding Use generous gel, roll nipple to the side, and use an angled view to evade theContinue reading “Papilloma breast”

Fibrocystic change of breast

A mixture of cysts, fibrosis and adenosis Diffuse involvement of both breasts Scattered calcifications, varying densities of glandularity, temporally changing cysts Cysts can be macro, cluster of micro, regional or diffuse This condition make it harder to detect any new onset malignancy and these patients should be monitored more closely

Fibroadenoma breast

Most common benign tumor Adult and juvenile form Contains stromal and epithelial element Well circumscribed, oval  lesions with edge shadowing, posterior enhancement on ultrasound, wide than tall. Hypermobile under the ultrasound probe Isointense to breast in T2 and can be seen to rapidly enhance post i.v. contrast administration Calcifications are commonly seen, causing edge shadowingContinue reading “Fibroadenoma breast”

Fibroadenolipoma breast

Breast-within-breast Pseudoencapsulated lesion containing varying levels of glandularity and fat Benign Can occur at any site in breast or in ectopic breast

Diffuse calcifications in breast

Random distribution of calcifications in both breasts Often benign Differentials Adenosis: premenopausal Sclerosing adenosis: postmenopausal Fibrocystic disease Skin calcifications Very rarely extensive DCIS

Secretory calcifications in breast

Duct ectasia with secretory deposits Benign calcifications Large rod shaped / cigar shaped Show a ductal pattern radiating from nipple 3-10 mm long Tends to be bilateral and extensive

Oil Cyst

Liquefied fat Can be seen in any part of breast Most common in subareolar region Range from few mm to cm in size Mammography Oval to round lucent smooth border lesion Develops rim calcification over time Calcification can be rim, egg-shell or coarse In early stages, same as surrounding fat and difficult to detect UltrasoundContinue reading “Oil Cyst”

Malignant microcalcifications (breast)

Associated with invasive breast cancer and DCIS Clustered, pleomorphic, in a ductal or linear distribution High grade DCIS – rod-shaped and branched. Also called casting or comedo microcalcifications – necrotic debris within ducts Imaging Mammogram Most sensitive and recommended for picking calcifications Ultrasound Poor detection of microcalcifications and is not recommended for screening Aids percutaneousContinue reading “Malignant microcalcifications (breast)”

Genetic screening in breast cancer

Recommendations for hereditary breast cancer 1 in 8 to 1 in 12 women develop breast cancer in their lifetime National Comprehensive Cancer Network guidelines for genetic counseling referral  Patient with personal history of breast cancer Diagnosis < 50 years of age  Triple negative breast cancer diagnosed at <60 years of age Personal history of twoContinue reading “Genetic screening in breast cancer”

Signs of malignancy in breast ultrasound