Mammography review for oral boards
Terms
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- Mammo shows bilateral axillary lymphadenopathy. Ddx?
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Lymphoma
Leukemia
Lupus
Sarcoid
RA - How do you manage a filling defect on ductogram or a mass in a cyst wall (give ddx on this)?
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Surgical removal.
In cyst w/ mass, DON'T try needle (lose mass w/o cyst fluid as bckground).
Ddx: Papilloma
Papillary carcinoma
Blood clot - Indication for ductogram
- Unilateral spontaneous discharge which is clear, bloody, or brown.
- How do you do a ductogram?
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0.1-0.3cc Optiray injected into duct with blunt 31g needle.
Get CC and 90deg ML views. -
Differential for
mammo finding:
SPICULATED MASS -
* Cancer
* Radial Scar, Biopsy Scar
* Fat necrosis, Sclerosing adenosis
* Abscess, Hematoma
* desmoid, granular cell tumor - Findings seen in implant rupture
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Saline - implant collapses
Silicone-
1) intracapsular - US shows "stepladder", MRI shows "linguine sign"
2) extracapsular - high density on mammo if gel in tissue. Gel seen in LNs. U/S - snowstorm appearance. - The "classically" benign types of mammographic calcifications
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"popcorn"
secretory
Skin calcs
Milk of calcium
Adenosis - rosettes - Breast lesion which shows shadowing on ultrasound. Ddx?
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Fibroadenoma
Granular cell tumor
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Radial scar
Surgical scar
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Fibrosis
Fat necrosis
Sclerosing adenosis
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Diabetic mastopachy
Normal breast tissue - Mammographic finding: well circumscribed mass. Which ones do you leave alone?
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Intramammary LN
Fibroadenoma with typical calcs
Lipoma
Hamartoma - Mammographic finding: well circumscribed mass. Which ones are "low" prob for cancer?
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simple cyst - done
complex cyst - MUST aspirate (medullary carcinoma often looks cystic)
solid mass - Unilateral inflammatory changes in breast (skin thickening, prominent trabecular markings). Management?
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Rule out RTX, trauma, lymphatic obstruction.
Tx with abx for 2 weeks. Mastitis will resolve, inflammatory breast CA won't. - Breast lesion with fat in it
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hamartoma
lipoma
galactocele
oil cyst - Breast mass with MACROlobulation
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Phylloides
Fibroadenoma
Cyst
LN - Breast mass with ring-like peripheral calcium
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Fibroadenoma
Calcified cyst
Oil cyst
Fat necrosis - Non-mass like enhancement on breast MRI
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Clumped - DCIS, carcinoma, seroma (post-bx)
especially if segmental distr
Reticular/Dendritic - involution, inflammatory CA - Appearance of post-op seroma on MR
- low on T1, with clumped enhancement extending to nipple
- Ddx for unilateral prominence of trabeculae
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Mastitis
Inflammatory CA
axillary mass
RTX