Uncommon benign breast masses

Transcription

1 Uncommon benign breast masses Poster No.: C-1310 Congress: ECR 2015 Type: Educational Exhibit Authors: Z. Erdem, O. Erdem, F. Barut, B. Dogan Gun, N. Kandemir, #. Serifoglu, I. I. Oz, Ö. yazgan, S. Güneyli; Zonguldak/TR Keywords: Breast, Mammography, Ultrasound, Biopsy, Neoplasia DOI: /ecr2015/C-1310 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 13

2 Learning objectives To characterize mammographic and ultrasonographic (US) features of uncommon breast masses, to compare the radiologic and histopathologic findings. Background Uncommon lesions of the breast can present a diagnostic challenge. Findings and procedure details Case 1 25 years old women with a palpable left breast mass, presented as focal acoustic shadowing without a mass configuration on ultrasound. Mammography was negative because of dense breast tissue. The patient was diagnosed as sclerosing adenosis by core needle biopsy under ultrasound (Fig1). Sclerosing adenosis is a benign proliferative disease of the breast. On clinical, radiological, and even histopathological examination, it can be confused with malignancy. On histopathological examination, sclerosing adenosis is present in 12% of benign and 5%-7% of malignant specimens (1). The disease has an increased incidence among reproductive-age and perimenopausal women, especially between 35 and 50 years of age (1-4), while our patient with sclerosing adenosis was 25 years old. There is no typical radiological criterion for diagnosis. The characteristic findings of sclerosing adenosis on mammography and ultrasonography have only rarely been described in the literatüre (5-6). On mammographic imaging, in asymptomatic patients, various findings such as mass lesions, microcalcifications, focal asymmetrical opacities Page 2 of 13

3 and architectural distortions can be detected. If there is a palpable mass, a tumoral mass lesion can also be detected by both mammography and ultrasonography. Our patient had palpable mass in the left breast with normal mammogram because of dense breast tissue, presented with only focal acoustic shadowing on ultrasound. Core needle biopsy or excisional biopsy can be used for diagnosis. In the diagnosis of sclerosing adenosis, core needle biopsy can be the first step (1). Our patient was diagnosed by core needle biopsy under ultrasound. Fig. 1: 25 years old women with a palpable left breast mass, presented as focal acoustic shadowing without a mass configuration on ultrasound. References: Bulent Ecevit University, School Of Medicine, Department of Radiology,Zonguldak, Turkey Figure years old women with a palpable left breast mass, presented as focal acoustic shadowing without a mass configuration on ultrasound. Page 3 of 13

4 Case 2: The women with a palpable right breast mass, showed encapsulated masses with a heterogeneous appearance with smooth lobulations on US. Mammography was negative because of dense breast tissue (Fig 2). Breast hamartoma is an uncommon breast tumor that accounts for approximately 4.8% of all benign breast masses. Breast hamartomas were initially defined as well-circumscribed tumors composed of varying amounts of epithelial elements in a fibrofatty stroma (7). Although different studies have used different criteria, the most common histologic feature is the presence of lobules within a fibrotic stroma (8). Hamartomas have a mammographic appearance typical of lucent lesions containing fat,varying radiodense fibrous and adenomatous elements, sharp margins, and, in some cases, a thin capsule (9). Conversely, breast hamartomas have wide sonographic variability (7-9). Our case had normal mammogram while showed encapsulated mass with a heterogeneous appearance on US. Our patient had core needle biopsy under ultrasound and was diagnosed fibroadenomatoid mass containing fat tissue (Figure 2-4). Page 4 of 13

5 Fig. 2: The women with a palpable right breast mass, showed encapsulated masses with a heterogeneous appearance with smooth lobulations on US. References: Bulent Ecevit University, School Of Medicine, Department of Radiology,Zonguldak, Turkey Page 5 of 13

6 Page 6 of 13

7 Fig. 3: Mammography was negative because of dense breast tissue. References: Radiology, Zonguldak Karaelmas University, Faculty Of Medicine, University Hospital - Zonguldak/TR Fig. 4: Morphological appearance compatible with fibroadenomatoid changes. The final diagnosis was hamartoma. References: Bulent Ecevit University, School Of Medicine, Department of Pathology,Zonguldak, Turkey Figure 2.The women with a palpable right breast mass, showed encapsulated masses with a heterogeneous appearance with smooth lobulations on US. Figure 3. Mammography was negative because of dense breast tissue. Figure 4. Morphological appearance compatible with fibroadenomatoid changes. The final diagnosis was hamartoma. Case 3 Page 7 of 13

8 45 years old women with a palpable left breast mass, who had a mass lesion on mammogram while circumscribed mass with smooth lobulations, slightly hyperechoic relative to the normal fat lobules, but was not as echogenic as the adjacent fibroglandular tissue and diagnosed by core needle biopsy under ultrasound (Figure 5-7). Angiolipoma is benign neoplasm, described as an uncommon variant of lipoma with vascular proliferation among mature adipocytes. While typically occuring on the trunk and extremities as multiple painful nodules in the subcutaneous tissues, they rarely occur in the breast (10). Angiolipoma has nonspecific imaging features. The most common mammographic appearance of angiolipomas of the breast in this series was an oval or round, isodense, circumscribed mass. The most common sonographic features were oval shape, circumscribed borders, and iso- to slight hyperechogenicity. Biopsy is required to ultimately make this diagnosis. Similarly, our case had a isodense, circumscribed mass lesion on mammogram while echogenic mass which diagnosed by core needle biopsy under ultrasound (Figure 5-7). Page 8 of 13

9 Fig. 5: 45 years old women with a palpable left breast mass, who had a circumscribed isodense mass lesion on mammogram References: Radiology, Zonguldak Karaelmas University, Faculty Of Medicine, University Hospital - Zonguldak/TR Page 9 of 13

10 Fig. 6: The mass has smooth lobulations, slightly hyperechoic relative to the normal fat lobules on sonogram. References: Radiology, Zonguldak Karaelmas University, Faculty Of Medicine, University Hospital - Zonguldak/TR Page 10 of 13

11 Fig. 7: Lipomatous tissue rich in vascular structures some of which contains thrombus. The final diagnosis was angiolipoma References: Bulent Ecevit University, School Of Medicine, Department of Pathology,Zonguldak, Turkey Figure years old women with a palpable left breast mass, who had a circumscribed isodense mass lesion on mammogram. Figure 6. The mass has smooth lobulations, slightly hyperechoic relative to the normal fat lobules on sonogram. Figure 7. Lipomatous tissue rich in vascular structures some of which contains thrombus. The final diagnosis was angiolipoma. Conclusion Page 11 of 13

12 Mammographic and ultrasonographic features of uncommon breast masses are presented and the radiologic and histopathologic findings are compared. Radiologists should be familiar with the characteristic mammographic and ultrasonographic appearances of these lesions and should consider in the differential diagnosis. Personal information Prof Dr C. Zuhal Sunar ERDEM, Bulent Ecevit University Hospital, Department of Radiology, Zonguldak, TURKEY, address: References 1.Ta#kin F, Köseo#lu K, Unsal A, Erku# M, Ozba# S, Karaman C. Sclerosing adenosis of the breast: radiologic appearance and efficiency of core needle biopsy. Diagn Interv Radiol Dec;17(4): doi: / DIR Epub 2011 Feb Tavassoli FA. Pathology of the breast. Norwalk: Appleton and Lange, 1992; Nielsen NS, Nielsen BB. Mammographic features of sclerosing adenosis presenting as a tumour. Clin Radiol 1986; 37: Rasbridge SA, Millis RR. Carcinoma in situ involving sclerosing adenosis: a mimic ofinvasive breast carcinoma. Histopathology 1995; 27: DiPiro PJ, Gulizia JA, Lester SC, Meyer JE. Mammographic and sonographic appearances of nodular adenosis. AJR Am J Roentgenol 2000; 175: Page 12 of 13

13 6. Günhan-Bilgen I, Memi# A, Üstün EE, Özdemir N, Erhan Y. Sclerosing adenosis:mammographic and ultrasonographic findings with clinical and histopathological correlation. Eur J Radiol 2002; 44: Tse GM, Law BK, Ma TK, Chan AB, Pang LM, Chu WC, Cheung HS.Hamartoma of the breast: a clinicopathological review. J Clin Pathol Dec;55(12): Charpin C, Mathoulin MP, Andrac L, et al. Reappraisal of breast hamartomas: a morphological study of 41 cases.pathol Res Pract 1994; 190: Hessler C, Schnyder P, Ozzello L. Hamartoma of the breast:diagnostic observation of 16 cases.radiology 1978; 126: Kryvenko ON, Chitale DA, VanEgmond EM, Gupta NS, Schultz D, Lee MW. Angiolipoma of the female breast: clinicomorphological correlation of 52 cases. Int J Surg Pathol Feb;19(1): Page 13 of 13