Breast Imaging Cases - MAMMOGUIDE - Learn Breast Imaging

×

DCIS – Segmental Calcifications

1/22/2021

DCIS Segmental Calcifications

IMAGING FINDINGS:

Standard mediolateral oblique (MLO) and Craniocaudal (CC) views of the right breast demonstrate extensive pleomorphic calcifications in a segmental distribution extending from the posterior chest wall to the nipple.

WHY IT MATTERS:

Ductal Carcinoma In-Situ (DCIS) is considered stage 0 breast cancer. It means all the abnormal cancer cells are still confined within the duct. This can also be referred to as an intraductal cancer.
A segmental distribution usually corresponds to a specific duct network. Because of this fact, it carries a suspicious connotation.

FURTHER READING:
High‐Grade Ductal Carcinoma In Situ: An Overview for the Radiologist (J Am Osteopath Coll Radiol 2013)

Radiation Induced Sarcoma

1/18/2021

Radiation Induced Sarcome

IMAGING FINDINGS: 

Tangential spot MLO view of a palpable lump in the left breast shows a superficial mass with ill-defined margins. Ultrasound evaluation of the palpable area of concern demonstrates an irregular mixed echogencity superficial mass.

WHY IT MATTERS:

Radiation-induced sarcoma (RIS) is a rare, aggressive malignancy that occurs in a small percent of women after treatment for breast cancer with lumpectomy and radiation therapy. The incidence is approximately 3 per 1,000 women treated with radiotherapy.
Radiation-induced sarcomas most commonly present with skin changes such as skin discoloration (ranging from red to purple), elevated skin, and skin thickening. There may or may not be an associated palpable mass.

FURTHER READING:
Radiation-Induced Sarcoma of the Breast: A Systematic Review (The Oncologist, 2012)

Tomo Predominant Finding on Mammography

1/11/2021

Tomo Predominant Finding on Mammography

IMAGING FINDINGS: 

Standard Craniocaudal (CC) and Mediolateral Oblique (MLO) views of the left breast (A and B) demonstrate heterogeneously dense breast tissue with no definite abnormality. Selected Craniocaudal tomosynthesis image (C.) shows an irregular spiculated mass in the lateral left breast.

WHY IT MATTERS:

Some findings show up only (or primarily) on the tomosynthesis images. Studies have shown that up to 8 – 10% of malignancies are primarily visible on the tomo images. Tomosynthesis is a better mammogram, it finds more cancers!
An abnormality identified only on the tomo images may require tomo to be used for the extra-views or for the final intervention.

FURTHER READING:
Outcome of Architectural Distortion Detected Only at Breast Tomosynthesis versus 2D Mammography (Radiology 2018)

Saline Implant Rupture

1/8/2021

Saline Implant Rupture

IMAGING FINDINGS: 

Craniocaudal and mediolateral oblique views of the left breast demonstrate a subpectoral saline breast implant. The implant is ruptured.

WHY IT MATTERS:

There is no mystery with a saline implant rupture. The saline rushes out and the deflated implant shell is left behind.
Saline implant ruptures usually present as a sudden, dramatic change in breast appearance and size after mild trauma to the breast.

FURTHER READING:
The Augmented Breast: A Pictorial Review of the Abnormal and Unusual (AJR 2011)

Extracapsular Silicone Implant Rupture

1/7/2021

Extracapsular Silicone Implant Rupture

IMAGING FINDINGS: 

Craniocaudal and mediolateral oblique views of the right breast demonstrate a subglandular silicone implant rupture. The implant is deformed with high density free silicone present along the upper outer margin.

WHY IT MATTERS:

The two main types of silicone implant rupture are intracapsular and extracapsular. Extracapsular ruptures occur when the silicone is no longer confined by the implant shell or the surrounding fibrous capsule. There is free silicone in the breast.
Extracapsular or free silicone can be taken up by axillary or intramammary lymph nodes. It is very high density on mammography.

FURTHER READING:
The Augmented Breast: A Pictorial Review of the Abnormal and Unusual (AJR 2011)

Breast Hamartoma

1/6/2021

Breast Hamartoma

IMAGING FINDINGS: 

Craniocaudal and mediolateral oblique views of the left breast show a large circumscribed mixed density mass occupying the upper outer quadrant. There are fat, calcifications and soft tissue density components to the mass.

WHY IT MATTERS:

Breast hamartomas (or fibroadenolipomas) are a benign proliferation of fibrous, glandular, and fatty tissue surrounded by a thin capsule of connective tissue.
Hamartoma’s contain all the components found in normal breast tissue, which is why the lesions have a “breast within a breast” appearance.
The presence of multiple hamartomas can be seen with Cowden’s Syndrome.

FURTHER READING:
Unusual Breast Lesions: Radiologic-Pathologic Correlation (RadioGraphics 1999)

Inflammatory Breast Cancer on Mammography

1/5/2021

IMAGING FINDINGS: 

Craniocaudal and mediolateral oblique views of the left breast demonstrate diffuse skin thickening, more prominent in the lower inner quadrant. No mass or suspicious calcifications are identified.

WHY IT MATTERS:

Inflammatory breast cancer (IBC) is a rare but highly lethal form of breast cancer. It presents as sudden onset of skin erythema and thickening. Usually there are not other mammographic findings.
The differential diagnosis for IBC includes mastitis, post-radiation change, and other inflammatory skin conditions.

FURTHER READING:
What Radiologists Need to Know about Diagnosis and Treatment of Inflammatory Breast Cancer: A Multidisciplinary Approach (RadioGraphics 2013)

Diffuse Calcifications on Mammography

12/23/2020

Diffuse calcifications on mammography

IMAGING FINDINGS: 

Craniocaudal and mediolateral oblique views of the right breast demonstrate diffuse punctate calcifications throughout the breast. No masses or architectural distortion is identified.

WHY IT MATTERS:

Microcalcifications are one of the things you look for when evaluating a mammogram, however the majority of calcifications are due to benign processes.
The distribution of calcifications can be useful in deciding whether the calcifications are benign or suspicious. Categories include:
- Diffuse
- Regional
- Grouped
- Linear
- Segmental
Diffuse calcifications tend to be benign, particularly if they are symmetric and bilateral.

FURTHER READING:
ACR BI-RADS Atlas Fifth Edition Quick Reference

Diabetic Mastopathy

12/21/2020

Diabetic Mastopathy

IMAGING FINDINGS:

Craniocaudal view demonstrates an asymmetry in the central right breast. Ultrasound evaluation revealed an irregular, heterogeneous mixed echogenicity mass with ill-defined margins and posterior acoustic shadowing.

WHY IT MATTERS:

Diabetic mastopathy is a rare complication of long-standing diabetes mellitus (typically type 1 DM).
It presents as suspicious appearing masses within the breast, often multiple. Biopsy is usually required to make a definitive diagnosis.

FURTHER READING:
Diabetic Mastopathy: Imaging Features and the Role of Image-guided Biopsy in its Diagnosis (Ultrasonography, 2016)

Direct Silicone Injections on Mammography

12/18/2020

IMAGING FINDINGS: 

Bilateral MLO views demonstrate innumerable high density small round masses within the breasts bilaterally. The patient had a history of direct silicone injections for cosmetic purposes.

WHY IT MATTERS:

Direct silicone injections are occasionally performed in some parts of the world as a form of breast augmentation. This procedure has serious adverse effects and is banned in most countries of the world (including the United States).
Imaging features are similar to the findings of extracapsular silicone implant rupture, however the free silicone is widespread throughout both breasts.
Direct silicone injections can make effectively screening the breast for malignancy nearly impossible.

FURTHER READING:
Imaging Spectrum of Extracapsular Silicone: Correlation of US, MR Imaging, Mammographic, and Histopathologic Findings (RadioGraphics, 1999)