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Male Breast Cancer

3/10/2021

Male Breast Cancer

IMAGING FINDINGS: 

Mediolateral oblique (MLO) and craniocaudal (CC) views of both breasts demonstrate an irregular mass in the subareolar left breast. There is associated nipple retraction. Corresponding ultrasound image shows a round mass with subtle spiculated margins.

WHY IT MATTERS:

Male breast cancer is rare but important to identify. Unfortunately, it often presents at a later stage where secondary findings such as nipple retraction, nipple discharge, axillary lymphadenopathy or metastases are present as well.
These secondary findings are an important clue in distinguishing between gynecomastia and male breast cancer.

FURTHER READING:
Male Breast Cancer in the Age of Genetic Testing: An Opportunity for Early Detection, Tailored Therapy, and Surveillance (RadioGraphics 2018)

Intramammary Node Mimic on Mammography

3/8/2021

Intramammary Node Mimic on Mammography

IMAGING FINDINGS: 

Mediolateral oblique (MLO) and craniocaudal (CC) views of the left breast demonstrate two round circumscribed masses in the upper outer quadrant posteriorly. Spot compression view confirms the finding. Ultrasound evaluation demonstrates two adjacent round hypoechoic masses. They do not have the characteristics of a lymph node. Biopsy revealed multifocal invasive ductal carcinoma.

WHY IT MATTERS:

Intramammary lymph nodes are a common finding in the upper outer quadrant of the breast. They are a normal variant and do not require further evaluation. However, don’t be fooled. Not all circumscribed masses in the upper outer quadrant are lymph nodes.
Intramammary lymph nodes have a classic appearance with a reniform shape, hyperechoic center on ultrasound, a fatty hilum or notch on mammography and central vascularity.

FURTHER READING:
Intramammary Lymph Nodes: Normal and Abnormal Multimodality Imaging Features (BJR 2019)

Low Grade DCIS on Mammography

3/5/2021

Low grade DCIS on mammography

IMAGING FINDINGS: 

Standard craniocaudal (CC) and mediolateral oblique (MLO) views demonstrate linear fine pleomorphic calcifications in the upper inner left breast.

WHY IT MATTERS:

Ductal Carcinoma In-Situ (DCIS) is the earliest form of breast cancer. It is referred to as a stage 0 breast cancer.
DCIS most commonly presents as suspicious calcifications on mammography.

FURTHER READING:
Radiologic-Pathologic Correlation of Ductal Carcinoma in Situ (RadioGraphics 2010)

Benign Oil Cysts

3/1/2021

benign oil cysts

IMAGING FINDINGS:

Craniocaudal and quad magnification view of the right breast demonstrate multiple fat density circumscribed masses consistent with benign oil cysts.

WHY IT MATTERS:

Oil cysts have a characteristic appearance with fat density centrally, often with a thin calcified rim.
Oil cysts are the end product of fat necrosis. They occur in the setting of prior trauma and oftentimes multiple oil cysts are present.

FURTHER READING:
Cystic Masses of the Breast (AJR 2010)

Radial Scar on Mammography

2/24/2021

Radial scar on mammography

IMAGING FINDINGS: 

Craniocaudal (CC) and Mediolateral Oblique (MLO) views of the right breast demonstrate an area of architectural distortion medially. Spot compression view confirms persistence of architectural distortion.

WHY IT MATTERS:

Architectural distortion is one of three main mammographic findings, along with masses and calcifications, that you are looking for when interpreting a mammogram. Tomosynthesis is particularly good at identifying architectural distortion.
Radial scars are fairly common benign breast lesions that present as architectural distortion. The main differential diagnosis for architectural distortion (in a patient who has not had prior surgery) is malignancy vs radial scar.

FURTHER READING:
Radial Scars/Complex Sclerosing Lesions of the Breast: Radiologic and Clinicopathologic Correlation (BMC Medical Imaging 2018)

Microlobulated Margins of a Breast Mass

2/23/2021

Microlobulated Margins of a Breast Mass

IMAGING FINDINGS: 

Standard craniocaudal (CC) and mediolateral oblique views of the right breast demonstrate a subcentimeter mass in the lateral right breast. Spot magnification view of the high density mass shows suspicious microlobulated margins.

WHY IT MATTERS:

Analysis of any mass identified on a mammogram includes evaluating the shape, margins and density.
The margins of a mass are the most important in deciding likelihood of malignancy. Categories of assessment include circumscribed, obscured, microlobulated, indistinct and spiculated.

FURTHER READING:
ACR BI-RADS® Atlas Fifth Edition QUICK REFERENCE

Pleomorphic Calcifications on Mammography

2/22/2021

Pleomorphic Calcifications on Mammography

IMAGING FINDINGS: 

Standard craniocaudal (CC) and mediolateral oblique views of both breasts demonstrate a grouping of fine pleomorphic calcifications in the subareolar right breast.

WHY IT MATTERS:

Calcifications are one of the main things you are looking for on a mammogram. They can be benign or malignant. The morphology of the calcifications helps to determine your level of suspicion.
Descriptors which imply suspicious morphology of calcifications include amorphous, coarse heterogeneous, fine pleomorphic and fine linear.

FURTHER READING:
ACR BI-RADS® Atlas Fifth Edition QUICK REFERENCE

Tattoo Sign for Skin Calcifications

2/15/2021

tattoo sign for skin calcifications

IMAGING FINDINGS: 

Craniocaudal (CC) views from two consecutive years demonstrate calcifications centrally. The calcifications are identical in morphology and distribution, known as the tattoo sign.

WHY IT MATTERS:

The tattoo sign is a sign of skin calcifications within the breast on a mammogram. The calcifications look identical from year to year because they are within the skin.
Skin calcifications often project along the skin on one of the two standard views. Additionally a tangential view or tomosynthesis can be helpful to make the diagnosis of benign skin calcifications.

FURTHER READING:
Distinguishing Breast Skin Lesions from Superficial Breast Parenchymal Lesions: Diagnostic Criteria, Imaging Characteristics, and Pitfalls (RadioGraphics 2011)

Mucinous Carcinoma on Mammography

2/11/2021

Mucinous Carcinoma on Mammography

IMAGING FINDINGS:

Standard Craniocaudal (CC) and Mediolateral Oblique (MLO) views of the right breast demonstrate an isodense, oval mass in the lower inner quadrant. The mass has primarily circumscribed margins, but is a new finding compared to prior exams.

WHY IT MATTERS:

Not all circumscribed masses on mammography are benign. Most will be either a cyst or fibroadenoma, but mucinous carcinoma is one of a few types of malignancy that can present as a relatively benign appearing mass on screening mammography. This case shows a new solid mass in a fifty year old patient, biopsy is always required, despite the relatively benign appearance.
Mucinous carcinoma is a subtype of invasive ductal carcinoma. It often has circumscribed margins and is T2 bright on breast MRI.

FURTHER READING:
Mucinous Carcinoma of the Breast: MRI Features of Pure and Mixed Forms with Histopathologic Correlation (AJR 2009)

COVID Vaccination Findings on Mammography

2/10/2021

COVID vaccination findings on mammography

IMAGING FINDINGS: 

Standard Mediolateral Oblique (MLO) views demonstrate an asymmetrically enlarged lymph node in the left axilla. No abnormality is identified in either breast. Sonographic evaluation of the left axilla demonstrates an abnormal enlarged lymph node with a thickened cortex. The patient reports that she had a COVID vaccination in the left arm two weeks ago.

WHY IT MATTERS:

There is hope in the COVID19 global pandemic as vaccines are being deployed. Vaccinations can cause temporary unilateral axillary lymphadenopathy. This is seen commonly after administration of the COVID19 and Shingles vaccines. The majority of patients with a recent vaccination will show some degree of axillary node enlargement on the side of vaccination. This typically resolves within several weeks.
Short-term follow-up of these patients is likely not required if the story fits, especially as the vaccine becomes more wide-spread. Reactive lymphadenopathy due to other causes is often followed until the nodes return to normal size. But given the prevalence of mild left axillary lymphadenopathy with a recent left arm vaccination site = we recommend to simply continue with regular screening. Please note, that some practices are recommending short-term follow-up, however at a busy practice in an area where COVID vaccination is occurring, this could be dozens of patients per day. Another approach for unilateral axillary lymphadenopathy with recent history of COVID vaccination and a normal screening mammogram is to perform screening ultrasound for those with dense tissue (to help ensure no occult malignancy), but otherwise return to routine screening.

FURTHER READING:
Unilateral axillary Adenopathy in the setting of COVID-19 vaccine (Elsevier 2021)

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