Radiologic Findings of Mucocele-like Tumors of the breast: Can we differentiate pure benign from associated with high risk lesions?

Transcription

1 Radiologic Findings of Mucocele-like Tumors of the breast: Can we differentiate pure benign from associated with high risk lesions? Poster No.: C-0332 Congress: ECR 2014 Type: Educational Exhibit Authors: E. K. Park, K. R. Cho, B. K. Seo, O. H. Woo, J. H. Lee, S. E Song, Y. W. Oh ; Seoul/KR, Ansan/KR Keywords: Cancer, Biopsy, Ultrasound, Mammography, Breast DOI: /ecr2014/C-0332 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 28

2 Learning objectives To evaluate radiologic findings of mucocele-like tumors of the breast To investigate any differential characteristics between pure benign tumor and associated with high risk lesions such as ADH and DCIS Page 2 of 28

3 Background Mucocele-like Tumor of the Breast Wide spectrum of lesions from benign to malignancy Fig. 1 How to differential diagnose of mucocele-like tumors? Fig. 2 Imaging findings of Mucocele-like Tumors Mammography -Extent of microcalcifications Page 3 of 28

4 ; malignancy > benign mucocle-like tumors Sonography -Associated with ADH or malignancy, clustered cysts, cysts with thick septations, complex masses Page 4 of 28

5 Images for this section: Fig. 1 Fig. 2 Page 5 of 28

6 Findings and procedure details MATERIALS and METHODS Retrospectively review of surgical pathology database, from January, 2008 to May, patients diagnosed with mucocele-like tumors of the breast-age range, years; mean, 42 years Patients and Lesions Initial pathologic diagnosis : sonographic guided core needle biopsy in all cases Final pathologic diagnosis by surgical excision Fig. 3 Imaging analysis Mammography : According to BI-RADS lexicon - Presence or absence of mass, asymmetry and microcalcifications - Mass : shape, margin, density - Microcalcifications : shape, distribution US : Presence or absence of mass, calcifications, or ductectasia Classified description of a masses 1. simple cyst 2. complicated cyst 3. cyst with thin (< 0.5mm) septation Page 6 of 28

7 4. clustered microcysts 5. cyst with thick ( 0.5mm) septation 6. complex mass 7. solid mass RESULTS Fig. 4 Fig. 5 Page 7 of 28

8 Case 1 Fig. 6: < 59-year-old woman with benign pure mucocele-like tumor> Sonography shows a mass as simple cyst, defined as anechoic mass with an imperceptible circumscribed border and posterior acoustic enhancement. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Case 2 Page 8 of 28

9 Fig. 7: < 43-year-old woman with benign pure mucocele-like tumor > Sonography shows a mass as complicated cyst, defined as lesions with homogeneous low-level echoes or presence of fluid-fluid or fluid-debris level. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Case 3 Page 9 of 28

10 Fig. 8: < 28-year-old woman with benign pure mucocele-like tumor > Sonography shows a mass as cyst with thin septation. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Case 4 Page 10 of 28

11 Fig. 9: < 43-year-old woman with benign mucocele-like tumor > A. Mammography with craniocaudal view of right breast shows a benign round calcification (arrow). B. Sonography shows a simple cyst with calcification. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Case 5 Page 11 of 28

12 Fig. 10: < 51-year-old woman with mucocele-like tumor associated with ADH > Sonography shows a mass with indistinct margin and this is classifed as complex mass, defined as presence of both solid and cystic component. Pathologic result by sonographic guided core was mucocele-like tumor associated with ADH and same result was revealed after operation. Case 6 Page 12 of 28

13 Fig. 11: <41-year-old woman with mucocele-like tumor associated with DCIS > A, B. Sonography shows irregular ductectasia with intraductal echogenic lesions. Pathologic result by sonographic guided core was mucocele-like tumor associated with DCIS and same result was revealed after operation. Case 7 Fig. 12: < 44-year-old woman with mucocele-like tumor associated with ADH > A. Mammography with craniocaudal view of right breast shows an indistinct irregular shaped hypderdense mass with multiple dystrophic calcifications. B. Sonography shows irregular ductectasia with intraductal echgenoic lesion. Pathologic result by sonographic guided core needle biopsy was pure mucocele-like tumor, but final diagnosis after operation revealed high risk lesion. Page 13 of 28

14 DISCUSSION Pathogenesis of mucocele-like tumors Fig. 13 Radiologic features of Mucocele-like tumors Most commonly a cystic mass on US (70%) -Similar to previous reports (AJR 2005;185: , AJR 2011; 196: ) Most had benign features, however, if a mass has a feature which is not typically benign (presence of solid portion, irregular ductectasia) Consider associated with high-risk lesion or malignancy Association with ADH, DCIS Fig. 14 Fine needle aspiration : difficult to differentiation pure mucocele-like tumor from mucinous tumor Core needle biopsy : possibility of underdiagnosis Excison is recommeded Imaging spectrum of mucocele-like tumors Page 14 of 28

15 Fig. 15 Page 15 of 28

16 Fig. 16 [Findings of simple cysts, complicated cysts, cyst with thin septations] Proven to benign in our study, and this is concordant as compared with previous study by Kim et al (AJR 2011; 196: ) May be possible to manage with follow-up after core biopsy [Findings of complex mass, irregular ductal change] Suspicious malignant finding and should be considered core needle biopsy Prevalence of malignancy 12.5% for complex masses, 33.3% for clustered cysts, 18.2% for cysts with thick septation by Kim et al (AJR 2011; 196: ) Page 16 of 28

17 Images for this section: Fig. 3 Fig. 4 Page 17 of 28

18 Fig. 5 Page 18 of 28

19 Fig. 6: < 59-year-old woman with benign pure mucocele-like tumor> Sonography shows a mass as simple cyst, defined as anechoic mass with an imperceptible circumscribed border and posterior acoustic enhancement. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Page 19 of 28

20 Fig. 7: < 43-year-old woman with benign pure mucocele-like tumor > Sonography shows a mass as complicated cyst, defined as lesions with homogeneous low-level echoes or presence of fluid-fluid or fluid-debris level. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Page 20 of 28

21 Fig. 8: < 28-year-old woman with benign pure mucocele-like tumor > Sonography shows a mass as cyst with thin septation. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Page 21 of 28

22 Fig. 9: < 43-year-old woman with benign mucocele-like tumor > A. Mammography with craniocaudal view of right breast shows a benign round calcification (arrow). B. Sonography shows a simple cyst with calcification. Pathologic result by sonographic guided core needle biopsy and operation revealed benign lesion. Page 22 of 28

23 Fig. 10: < 51-year-old woman with mucocele-like tumor associated with ADH > Sonography shows a mass with indistinct margin and this is classifed as complex mass, defined as presence of both solid and cystic component. Pathologic result by sonographic guided core was mucocele-like tumor associated with ADH and same result was revealed after operation. Page 23 of 28

24 Fig. 11: <41-year-old woman with mucocele-like tumor associated with DCIS > A, B. Sonography shows irregular ductectasia with intraductal echogenic lesions. Pathologic result by sonographic guided core was mucocele-like tumor associated with DCIS and same result was revealed after operation. Fig. 12: < 44-year-old woman with mucocele-like tumor associated with ADH > A. Mammography with craniocaudal view of right breast shows an indistinct irregular shaped hypderdense mass with multiple dystrophic calcifications. B. Sonography shows irregular ductectasia with intraductal echgenoic lesion. Pathologic result by sonographic guided core needle biopsy was pure mucocele-like tumor, but final diagnosis after operation revealed high risk lesion. Page 24 of 28

25 Fig. 13 Fig. 14 Page 25 of 28

26 Fig. 15 Fig. 16 Page 26 of 28

27 Conclusion Benign mucocele-like tumor usually shows a cyst or cyst with calcification, thin septation. Sonographic findings such as complex mass or irregular ductal change are findings of mucocele-like tumor associated with ADH or DCIS. Sonographic examination can help differentiate pure benign mucocele-like tumor from associated with ADH or DCIS and manage of mucocele-like tumors Page 27 of 28

28 References Fisher CH, Millis RR. A mucocele-like tumour of the breast associated with both atypical ductal hyperplasia and mucoid carcinoma. Histopathology 1992;21: Kim JY, Han BK, Choe YH, Ko YH. Benign and malignant mucocele-like tumors of the breast: mammographic and sonographic appearances. AJR 2005;185: Carder PJ, Murphy CE, Liston JC. Surgical excision is warranted following a core biopsy diagnosis of mucocele-like lesion of the breast. Histopathology 2004;45: Chang YW, Kwon KH, Goo DE, Choi DL, Lee HK, Yang SB. Sonographic differentiation of benign and malignant cystic lesions of the breast. J Ultrasound Med 2007;26: Berg WA, Compassi CI, Ioffe OB. Cystic lesions of the breast: sonographicpathologic correlation. Radiology 2003;227: Kim SM, Kim HE, Kang DK, Shin HJ, Cho N, Park JM, Cha JH, Mucocelelike tumors of the breast as cystic lesions: sonographic-pathologic correlation. AJR 2011;196: Page 28 of 28