Mrozin md BENIGN MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta...
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Transcript of Mrozin md BENIGN MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta...
mrozin md
BENIGN MASSES IN BREAST ULTRASOUND
Dr. Mona RozinDirector of Breast Imaging
Assuta Medical Centers
mrozin md
Benign MassesI. FibroadenomaII. Fibroadenoma variants : complex FA
tubular adenoma, lactating adenoma
III. Phylloides TumorIV. HamartomaV. LipomaVI. Focal FibrosisVII. Diabetic mastopathyVIII.Fibrocystic change
mrozin md
I. Fibroadenoma
• Arise from a single TDLU and contain both stromal (fibroma) & epithelial (adenoma) elements
• Edge is “pushing” not infiltrating &
becomes “encapsulated” by compressed breast tissue
• FAs with cysts, apocrine metaplasia, or sclerosing adenosis are called COMPLEX
mrozin md
FA – cont.
• Peak incidence – 20-30 yr & again 40-50 yr
• Usually 2-3 cm but giant FA & juvenile FA can grow to 10 cm
• Estrogen stimulation is important so most common when unopposed (anovulatory) i.e.. in adolescence and perimenopause
• Multiple in 25% also bilateral
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FA – sonographic appearance
• Oval, lobulated • Circumscribed with echogenic capsule• Parallel • Iso or hypoechoic• Normal or enhanced transmission with
edge shadows• Tiny ones (<1cm) may be round &
can’t DD from a complex cyst• May mimic duct extension
mrozin md
oval
lobulated
irregular
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isoechogenic
hypoechogenic
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Calcifications in FA
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Ca++
FA in pathology
mrozin md
FA – cont.
• Wide variability in histologic composition• Wide variability in sonographic
appearance
• Bilateral multiple FAs up to 10 nodules in each breastno need to Bx all of themnew ones will almost always developneed 6 mo. F/U
mrozin md
II. FA variants – Complex FA
• The epithelial components undergo proliferative change and we may see:sclerosing adenosis, cysts, apocrine metaplasia, amorphous calcifications
• About 20% of all FAs are complex !(-) FHx increases risk for CA 3x (+) FHx increases risk for CA 4x
• Risk is generalized for the whole of both breasts.
mrozin md
II. FA variants – Complex FA
• The diagnosis is histological • U/S: may see internal cysts or
heterogeneous echo pattern • Seen at older age – median age 47 yrs• Only 1.5% contained a CA
AJR:2008;190:214-218
mrozin md
Complex
FAs
cysts & sclerosis
mrozin md
II. FA variants – Tubular Adenoma & Lactating
Adenoma
• Almost pure epithelial growth with very little or NO stromal component
• Tubular adenoma is very rare• Lactating adenoma is common
during pregnancy (mainly 3rd trimester) and lactation
mrozin md
II. FA variants – Tubular Adenoma & Lactating
Adenoma
• Lactating adenoma may arise de novo, from a FA or from a tubular adenoma
• U/S: oval, spindle shaped, parallel, hypo-hyperechoic, enhancement, Doppler (+), microlobulated
mrozin md
spindle shaped
microlobulated
Tubular adenomas
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hyper
hypo
IDC-Grade 3
Lactating adenomas
mrozin md
III. Phylloides Tumor
• Rare – peak at 40-50 yr but can occur in teenagers
• Very rapid growth – up to 15 cm• 2/3 benign 1/3 malignant• Mix of very cellular stromal and
epithelial elements • U/S: oval, well circumscribed,
capsule, hypo, enhancement, “cystic slits”
mrozin md
Phylloides with cystic clefts
mrozin md
The faces of phylloides
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IV. Hamartoma
• Localized overgrowth of fibrous, epithelial and fatty elements = normal breast tissue
• Other names: adenolipofibroma, lipoadenofibroma, fibroadenolipoma
• U/S: oval, very heterogeneous, capsule, parallel
mrozin md
Classic hamartoma
mrozin md
Hamartoma on mammo & CT
mrozin md
V. Lipoma
• Overgrowth of fatty tissue• They are actually in the skin NOT in
the breast • May grow up to 20 cm !!!!
• U/S: completely isoechoic with the other fat lobules or mildly hyperechoic, soft and compressible
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hyper
iso
fat necrosis
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VI. Focal Fibrosis
• FIBROUS MASTOPATHY
• Can cause tender/non-tender palpable lump
• May see focal asymmetry on mammo – UOQ
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VI. Focal Fibrosis
• Pathology: dense stromal fibrous tissue without cells
• U/S: purely hyperechoic & homogeneous,
no capsule tapers into Cooper’s ligaments so can be teardrop or spindle shaped
BEWARE: DD with echogenic rim !!!
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MUST have mammographic correlation
mrozin md
VII. Diabetic Mastopathy
• Occurs in premenopausal women • Most have Type I diabetes before
the age of 20 yr
• Usually a very hard palpable lump• May be multifocal, multicentric
and bilateral
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VII. Diabetic Mastopathy
• Mammo: non specific asymmetry
• U/S: VERY SCARY !!!!!! Ill-defined, angular, microlobulated, hypoechoic, not parallel, intense shadowing
• ALL go to Bx.
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mrozin md
mrozin md
VIII. Fibrocystic Change• Huge spectrum from all the types of
cystic change to benign proliferation forming a solid nodule
• Adenosis & Sclerosing Adenosis:TDLUs enlarge and increase in numbernormal lobules – 2 mmadenosis – 5 mm
• Mammo: focal asymmetry, masses, “starry night” calcifications
• U/S: extremely varied
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mrozin md
mrozin md
adenosis with cysts
hypoechoic adenosis in hyper glandular tissue
adenosis with amorphous ca++
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Adenosis and blunt duct adenosis
mrozin md
adenosis
blunt duct adenosis
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“starry night” of sclerosing adenosis
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The faces of sclerosing adenois
distended terminal lobule
branching
central fibrosis
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Sclerosing adenosis with spiculation & halo
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Sclerosing adenosis with ca++
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• Remember algorithm and technique
• Know your anatomy
• Must correlate with mammo & clinical presentation
• Huge overlap of findings
• Better than doing mammograms all day!
mrozin md