DDx for amorphous Ca++:
Fibrocystic change (most likely)
sclerosing adenosis
DCIS (low grade)
DDx course heterogeneous Ca++:
Fibroadenoma
Papilloma
Fibrocystic change
DCIS (low-intermediate grade)
DDx fine pleomorphic Ca++:
Fibroadenoma (less likely)
Papilloma (less likely)
Fibrocystic change
DCIS (high grade)
Dark star - distortion without a central mass DDx:
lobular carcinoma
Radial Scar
Surgical scar
IDC NOS
- malignant characteristics on US:
SHAME BS CD
Spiculation, Height > Width, Angular margins, Microlobulations, Echogenicity (hypo), Branch pattern, Shadowing, Calcification, Duct extension
benign characteristics on US: \
CHEW
Capsulated (thin, complete),
Hyperechoic,
Ellipsoid (width > height),
Well circumscribed lobulations.
Sub types of DCIS:
Comedo
Non-comedo:
- Cribiform
- Micropapillary
- Papillary
- Solid
Lobular carcinoma in situ is its own In situ form.
Sub types of Invasive Ductal Carcinoma:
Non special type
Tubular:
- small spiculated mass
Mucinous colloid:
- low density circumscribed mass.
- T2 bright
Medullary:
- younger women, BRCA 1
- Locally aggressive, but better prognosis than NOS.
- tripple negative.
Papillary:
- intraductal
Complex cyst in lactating woman:
- Galactocele
- Abscess –> follow up post treatment to ensure not cancer
- Fibroadenoma
- Haematoma
- Lactating adenoma
- Fibrocystic change
Course Ca++ in partially circumscribed mass:
Degenerating fibroadenoma Fat necrosis Oil cyst Haematoma Previous abscess.
Fatty Breast Lesion:
Hamartoma / fibroadenolipoma = breast in breast
Lipoma
Galactocele
Fat necrosis.
Well circumscribed Mass in pre menopausal woman:
Fibroadenoma Cyst Intra mammary node Breast carcinoma Papilloma.
Axillary lymphadenopathy:
Breast cancer with nodal spread Lymphoma Reactive lymphadenopathy Metastatic disease from remote primary Connective tissue and granulomatous disease Castleman disease
Mass with central lucency:
Radial scar
Invasive ductal carcinoma
TUbular carcinoma
Fat necrosis
Post surgical scar.
Well circumscribed solid breast mass:
Fibroadenoma Intra mammary node Hamartoma / fibroadenolipoma Circumscribed carcinoma Papilloma
Well circumscribed cystic breast mass:
Papilloma / papillary carcinoma Seroma Cyst with debris Haematoma Abscess.
Ductal Mass:
Intraductal papilloma
Intra cystic papillary carcinoma
DCIS
Dilated duct with debris.
Bilateral skin thickening:
Congestive heart failure SVC obstruction Bilateral lymphoedema Psoriasis Renal failure and over load.
Breast lesion in a man:
Gynaecomastia Breat cancer Lipoma haematoma Abscess Metastasis
Well circumscribed breast cancer:
Invasive Ductal carcinoma not other wise specified Mucinous colloid carcinoma Medullary carcinoma Papillary carcinoma DCIS
Breast Lesion with nipple discharge:
Intraductal papilloma Mammary duct ectasia Breast carcinoma (Ductal or papillary) Fibrocystic change Galactorrhea
Unilateral nipple / skin changes:
Paget disease of nipple
Mastitis
Inflammatory breast carcinoma
Nipple adenoma
Large breast mass:
Phyllodes tumour:
- dense circumscribed mass, hypoechoic
- No Ca++
- Cannot reliably differentiate from fibroadenoma
- suspected with a Hx of rapidly growing circumscribed mass.
Fibroadenoma
Circumscribed breast cancer.
Complex cystic mas on US:
Abscess Haematoma Cystic neoplasm Fat necrosis Cyst with debris
