Imaging findings of malignancies arising within benign breast lesions

Transcription

1 Imaging findings of malignancies arising within benign breast lesions Poster No.: C-0194 Congress: ECR 2015 Type: Authors: Educational Exhibit F. Can 1, Ö. S. Okcu 2, A. Oktay 2, I. G. Bilgen 3 ; 1 Kutahya/TR, 2 Izmir/TR, 3 Bornova-#zmir/TR Keywords: DOI: Neoplasia, Cancer, Biopsy, Ultrasound, MR, Mammography, Breast /ecr2015/C-0194 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 17

2 Learning objectives To demonstrate the radiologic findings of malignant changes developed in benign breast lesions. To evaluate the radiologic management of these cases. To increase awareness of this uncommon entity. Background A malignancy arising in a benign breast lesion is extremely rare. Fibroadenomas are the most commonly documented lesions in the literature, usually as case reports, to harbor malignancy as DCIS and LCIS (1,2,3,4). Here we present a wider range of benign lesions giving rise to malignancy inside, in association with pathology results. Findings and procedure details Radiology database, between the years of 1982 and 2014, including patients with breast lesions was reviewed retrospectively. Pathology database was reviewed for the patients who had an excisional biopsy after imaging. Imaging modality was sonography (US) and/or mammography and MRI in some cases. There were 11 benign lesions, revealed to have in situ or invasive carcinoma inside, after the excisional biopsy. 10 lesions were BIRADS 3 on the basis of radiologic features and were operated on patient preference or due to rapid growth on follow-up. Only a patient was categorized as BIRADS 4. Histopathologic evaluation revealed malignancy arising in fibroadenomas in 4 patients,in intraductal papillomas in 5 patients and malignancy within benign phyllodes tumor in 1 patient. The last case was an hamartoma harboring malignancy inside. These findings are summarized in Table 1. Page 2 of 17

3 Table 1 References: EGE UNIVERSITY HOSPITAL - Izmir/TR Images for this section: Page 3 of 17

4 Page 4 of 17

5 Fig. 1: A well-circumscribed,lobulated mass in UIQ of the right breast. Fig. 2: US of the same patient demonstrated a solid,hypoechoic and circumscribed nodule of 2X1 cm, suggestive of a fibroadenoma.it was operated on patient preference. Histopathologic examination revealed a glycogen-rich carcinoma arising in a fibroadenoma. Page 5 of 17

6 Fig. 3: A solid,lobulated well-circumscribed nodule of 2.3X1.2 cm in the left breast which was unclear on mammograms because of dense parenchyma. This was a fibroadenoma having foci of IDC and ILC inside. Page 6 of 17

7 Fig. 4: An ovoid well-circumscribed nodule of 1cm in inner quadrant of the right breast. Page 7 of 17

8 Fig. 5: US of the same patient showed a solid and mobile nodule with distinct and regular margins, was confirmed to be a fibroadenoma with LCIS arising inside. Page 8 of 17

9 Fig. 6: Mammography images of the right breast revealed an asymmetric density in upper inner quadrant with indistinct margins due to dense parenchyma. Page 9 of 17

10 Fig. 7: On US of this patient, there was an ovoid,well-circumscribed hypoechoic solid nodule with regular margins (2x0.7cm).This was suggestive of fibroadenoma.it was harboring tubulo-lobular carcinoma as confirmed by pathology. Page 10 of 17

11 Fig. 8: A BIRADS 3 periareolar nodule of 1.2x0.7cm in UIQ of right breast.after excisional biopsy,it was diagnosed as intraductal papilloma harboring low-grade DCIS. Page 11 of 17

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13 Fig. 9: A well-circumscribed nodule of 2.5x1.4cm in left breast. Fig. 10: On US of the same patient, nodule was solid and lobulated with clear margins. It was classified as BIRADS 3 but was operated due to increase in size on follow-up. Pathology reported it as an atypical intraductal papilloma and DCIS arising inside. Page 13 of 17

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15 Fig. 11: CC mammogram of right breast showed a well-circumscribed mass (8x5 cm)comprising of both fat and soft-tissue densities, suggestive of hamartoma. It had amorphous calcifications with distortion detected inside. And classified as BIRADS 4. Fig. 12: The mass was mainly hyperechoic surrounded by a thin capsule. It had an irregular hypoechoic area of distortion causing acoustic posterior shadowing. Pathology revealed it as an hamartoma and IDC arising inside. Page 15 of 17

16 Conclusion The development of carcinoma in a benign breast lesion is a rare occurance. Preoperative diagnosis is challenging and usually is an incidental pathologic finding in case the lesion is excised (1,2). Radiologic findings rarely indicate malignancy and the patients are often followed-up. Fibroadenomas are most frequently reported benign lesions, with an incidence of %. There are cases in the literature (1,4). The most frequent tumor encountered in fibroadenoma is reported as DCIS and LCIS, invasive tumors are rare (5,6,7). Hamartomas harboring malignancy are reported even rarer. There are 13 cases in the literature. Kai et.al had reported such a case with IDC occuring in an hamartoma as in our case (8). Intraductal papilloma is another benign lesion, we encountered to have malignancy inside as DCIS and intracystic papillary carcinoma. There is only one such a case, in the literature, reported to have DCIS arising in an intraductal papilloma in an axillary lymph node (9). As far as we know, tubulolobuler carcinoma and glycogen-rich carcinoma have not been reported in the literature, to arise in a fibroadenoma. So as, squamous-cell carcinoma arising in benign phyllodes tumor. In women with a strong family history for breast cancer or a BRCA mutation and in women over 40, this risk is higher. Besides, it is needed to be cautious against probably benign lesions having indistinct margins or clustered micro calcifications during follow-up (1,3,7). Radiologists should be aware of this entity and should be alert to warn the surgeon against any morphologic change during follow-up. This study highlights the importance of a careful diagnostic approach towards benign appearing solid breast lesions. Personal information Page 16 of 17

17 References 1.Chintmani, Khandelwal R, Tandon M, Yashwant K, Kulshreshtha P, Aeron T, Bhatnagar D, Bansal A, Saxena S. Carcinoma developing in a fibroadenoma in a woman with a family history of breast cancer: case report andreview of literature. Cases J Dec 18;2: Tiu CM, Chou YH, Chiou SY, Hsu CY, Chen SP, Chiang HR, Lai CR, Tseng LM, Wang HK, Chiou HJ. Development of a carcinoma in situ in a fibroadenoma: color Doppler sonographic demonstration. J Ultrasound Med Oct;25(10): Kuijper A, Mommers EC, van der Wall E, van Diest PJ. Histopathology of fibroadenoma of the breast. Am J Clin Pathol May;115(5): Ooe A, Takahara S, Sumiyoshi K, Yamamoto H, Shiba E, Kawai J. Preoperative diagnosis of ductal carcinoma in situ arising within a mammary fibroadenoma: a case report. Jpn J Clin Oncol Jul;41(7): Blanco M, Egozi L, Lubin D, Poppiti R. Adenoid cystic carcinoma arising in a fibroadenoma. Ann Diagn Pathol Jun;9(3): Stafyla V, Kotsifopoulos N, Grigoriades K, Kassaras G, Sakorafas GH. Lobular carcinoma in situ of the breast within a fibroadenoma. A case report. Gynecol Oncol Aug;94(2): Kuijper A, Preisler-Adams SS, Rahusen FD, Gille JJ, van der Wall E, van Diest PJ. Multiple fibroadenomas harbouring carcinoma in situ in a woman with a family history of breast/ovarian cancer. J Clin Pathol Oct;55(10): Kai M, Tada K, Tamura M, Gomi N, Horii R, Akiyama F, Iwase T. Breast cancer associated with mammary hamartoma. Breast Cancer Apr;19(2): JafferS,LinR,BleiweissIJ,Nagi C.Intraductal carcinoma arising in intraductal papilloma in an axillary lymph node:review of the literature and proposed theories of evolution. Arch Pathol Lab Med Dec;132(12): Page 17 of 17