images

Question 1

white on mammogram

Answer 1

fibroglandular tissue

Question 2

grey on mammogram

Answer 2

fatty tissue

Question 3

what is coopers ligament

Answer 3

connective tissue in the breast that helps to maintain structural integrity

Question 4

Answer 4

asymmetry

Question 5

Answer 5

B - architectural distortion

C - microcalcification

D - mass

Question 6

Answer 6

dense breasts

Question 7

Answer 7

fatty breasts

Question 8

Answer 8

multiple round masses of varying size in both breasts. masses are very well defined, have a black halo (benign appearance on mammography)

Appearance in keeping with cysts however requires an ultrasound to make a definitive diagnosis

Question 9

imaging of choice in women < 40 years

Answer 9

ultrasound

Question 10

Answer 10

A - skin

E - fatty tissue

B - fibroglandular tissue

D - pectoralis major muscle

C - rib

Question 11

Answer 11

Well defined rounded mass with black, anechoic fluid centre

= cystic mass

Question 12

Answer 12

Solid mass

(as on USS; solid tissue appears as varying shaded of grey)

Question 13

Answer 13

Malignant mass

• irregular shaped, ill defined margins and invades across normal tissue planes indicated by the appearance of surrounding tissue

Question 14

management of patients with normal pre operative axillary assessment

Answer 14

benign mass because:

• rounded shape
• well defined borders
• benign tissue tends to push the surrounding tissue out of the way

Question 15

management of patients with normal pre operative axillary assessment

Answer 15

sentinel node biopsy

Question 16

management of patients with abnormal axillary nodes on ultrasound + confirmed by core biopsy/FNA

Answer 16

axillary node clearance

Question 17

what is a sentinel node?

Answer 17

the first of the axillary lymph nodes that will collect cancerous cells, if the cancerous breast cells have entered the lymphatic system

Question 18

Answer 18

FNAC - normal breast ductal epithelial cells because; uniform in size and appearance, cohesive and contain regular round nuclei

Question 19

Answer 19

FNAC - C5: malignant cells from breast carcinoma

• cells are scattered singly and contain varibaly sized irregular nuclei
• background contains cell debris (due to karyorrhexis which is breakdown of nuclei)

Question 20

Answer 20

Core biopsy - normal breast tissue

Question 21

Answer 21

core biopsy - invasive ductal carcinoma

Question 22

advantages of core biopsy over FNAC

Answer 22

• interpretation does not require a highly trained and experienced pathologist
• can be easier to classify a malignant lesion as invasive or non invasive
• sample includes more tissue than in FNAC
• cytology preparations can ascertain receptor status of a cancer

Question 23

Answer 23

benign fibroadenoma

benign neoplasm of both the stromal and epithelial cell components of the breast. Well circumscribed, non infiltrative lesion that lacks atypia

Question 24

Answer 24

benign fibrocystic changes

(can fluctuate with hormonal changes)

Question 25

Answer 25

malignant ductal carcinoma - irregular, infiltrative borders that are described as spiculated/star lik eon radiographic images.

Question 26

Answer 26

1 - chest wall 2 - pectoralis major 3 - breast lobules 4 - nipple 5 - aerola 6 - milk ducts 7 - fatty tissue 8 - skin/inframammary fold

Question 27

which structure is breast cancer thought to arise from?

Answer 27

TDLU = terminal duct lobar unit

Question 28

Answer 28

US image of breast that is breastfeeding - glandular enlargement - engorgement of breast tissue --\> echogenecity of breast parenchyma

Question 29

Answer 29

- Smooth 20 mm lump @ 4 o clock in left breast, about 2 cm from left nipple - 20 mm mass 12 o clock on contralateral right breast lying 1 cm from nipple

Question 30

Answer 30

Pagets disease

Question 31

Answer 31

Montgomery tubercles (sebaceous glands in the aerola around the nipple... are more pronounced during pregnancy)

Question 32

Answer 32

USS of solid mass w/ ovoid shape + well defined fibroadenoma

Question 33

Answer 33

multiple popcorn calcification multiple fibroadenomas that have shrunk and undergone calcification due to post menopause

Question 34

Answer 34

multiple round opacities of varying size. well defined have "black halo" which is a benign feature on mammography *appearance in keepign with cysts.*

Question 35

Answer 35

USS showing a well defined rounded mass with a black anechoic fluid centre. ## Footnote *breast cyst.*

Question 36

what does this show + next steps in management?

Answer 36

- microcalcification - magnification view on mammogram: close up detailed image of small area of breast tissue