Biopsy is usually indicated to establish the correct diagnosis and to rule out breast cancer. Management should be determined by the clinical examination, imaging studies, and core biopsy results [62]. Deep fibromatoses or desmoid tumors (also termed aggressive fibromatosis) are benign fibrous proliferations at musculoaponeurotic sites, most common in adults between the ages of 25 and 35,33 and multiple in 15% of cases. The patient underwent surgical excision. The patient underwent three core needle breast biopsies of the mass in the left breast over the span of a month, and a skin punch biopsy. (2008) ISBN: 9780071465427 -, 4. Ultrasound is routinely used to evaluate palpable soft tissue masses. Mimickers of breast malignancy: imaging findings, pathologic concordance and clinical management, https://doi.org/10.1186/s13244-021-00991-x, http://creativecommons.org/licenses/by/4.0/. The clinical course of desmoid fibromatosis varies between patients. Fat necrosis is a proliferative condition commonly seen as a result of breast surgery, infection, trauma, or radiation. Ultrasound cannot reliably distinguish between schwannoma and neurofibroma. Solid and complex cystic masses detected on ultrasound require further imaging evaluation with CT and/or MRI for proper characterization. Although tubular adenoma and fibroadenoma are both epithelial tumors, a tubular adenoma is histologically distinguished from a fibroadenoma by its tightly packed tubular or acinar epithelium and sparse connective tissue. AJR Am J Roentgenol 197(3):755762, Malik N, Lad S, Seely JM, Schweitzer ME (2014) Underestimation of malignancy in biopsy-proven cases of stromal fibrosis. 5). Core needle biopsy showed sclerosing adenosis in a background of dense fibrosis without atypia or carcinoma. Awareness of multiple malignancy mimickers, rare and common, is vital to clinical practice and plays a key role in radiologic-pathologic concordance, ensuring appropriate clinical management. Architectural distortion can also be an imaging feature of sclerosing adenosis. Kidney masses, or tumors, are growths that develop on the kidney. Additionally, this entity can be seen in the setting of malignancy [37]. We have classified mimickers of breast cancer into three groups: inflammatory breast conditions, proliferative breast conditions, and benign breast tumors (Fig. What does hyperechoic indicate? Br J Radiol 87(1039):20140182, Yilmaz R, Bayramoglu Z, Kartal MG et al (2018) Stromal fibrosis: imaging features with diagnostic contribution of diffusion-weighted MRI. If encapsulated, the capsule may be difficult to identify on ultrasound 5. What is Isoechoic in ultrasound? In recent years, expectant conservative management is becoming the treatment of choice, especially in mild cases. Increased through-transmission deep to a nerve sheath tumor is common, arrows in A and between cursors and arrows, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window). Stromal fibrosis. Although granular cell tumors are benign, wide local surgical excision is indicated owing to their locally infiltrative nature [75, 80]. Radiology. Avoid heavy pressure when performing Doppler examinations, or vascularity may be effaced or reduced. Thorough imaging assessment of these cases is important. Folpe AR, Fritchie K, Goldblum J, Mertens F, Lipoma. Benign solid lesions adenomatoid tumor of the scrotum : most common epididymal mass 4 epididymal leiomyoma papillary cystadenoma of the epididymis How can you tell if a thyroid nodule is malignant? Breast ultrasound (d) shows a corresponding irregular hypoechoic mass with associated posterior acoustic shadowing (arrow). more echogenicity than fat or equal to fibroglandular tissue; Case Rep. https://doi.org/10.1136/bcr-2012-008178, Article Figure 2. Core needle biopsy showed acute and chronic inflammation and granulation tissue. 2a) [2]. Ultrasound Med Biol 30(1):16, Eryilmaz R, Sahin M, Hakan Tekelioglu M, Daldal E (2004) Management of lactational breast abscesses. If the imaging findings are more suspicious such as an irregular mass or pleomorphic calcifications in a segmental or linear distribution, repeat biopsy is recommended to exclude a coexisting malignancy. 3 Limitations primarily relate to evaluation of deep soft tissue structures, bone, and masse. There is associated axillary adenopathy (solid arrow in e). Confirmation of a malignant tumor typically initiates staging with thoracic computed tomography (CT) and possibly an isotope bone scan to identify potential metastases. Sclerosing adenosis. Often termed a breast within a breast, breast hamartomas are circumscribed benign tumors that are composed of variable amounts of fat, fibrous tissue, and glandular tissue. An isoechoic nodule replaces the right lobe of the thyroid. Musculoskeletal Imaging Cases. Most malignant masses are predominantly hypoechoic, usually with low-level echoes or heterogeneity, and well defined as they have pseudocapsules. The clinical presentation of several benign breast conditions, common and rare, can mimic breast cancer. Categories of benign breast diseases that can mimic breast cancer. SA J Radiol 22(2):1366, Bowman E, Oprea G, Okoli J et al (2012) Pseudoangiomatous stromal hyperplasia (PASH) of the breast: a series of 24 patients. Although it can coexist with malignant lesions [49, 50], PASH itself is a benign entity without an increased risk for malignancy [51]. T1-weighted post-contrast fat-saturated MRI of the chest (c) shows invasion of the pectoralis major muscle by this irregular enahancing mass (dotted arrow). Increased vascularity can also be seen (Fig. Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast entity that presents with a wide spectrum of imaging features. Nishida J, Morita T, Ogose A et al. Benign inflammatory breast conditions constitute a heterogeneous group of breast conditions characterized by a marked inflammatory process. Core needle biopsy of the mass showed stromal fibrosis without evidence of malignancy. Most epididymal lesions are benign; malignant lesions are rare. Eur J Cancer 127:96107, Fiore M, Rimareix F, Mariani L et al (2009) Desmoid-type fibromatosis: a front-line conservative approach to select patients for surgical treatment. They are common, have a prevalence of 2.1%, and account for nearly half of all soft tissue masses. Sonographic findings of stromal fibrosis include masses and non-mass lesions. Privacy It can, however, mimic malignancy when presenting with suspicious features such as an irregular mass or focal areas of shadowing without a mass (Fig. . MRI usually shows a heterogeneously enhancing mass, often with a progressive enhancement pattern. Less than 10% of desmoid tumors are found in the breast; more common locations include the abdominal wall, retroperitoneum, and the mesentery. 15) [42]. liposarcoma,adrenal myelolipoma,angiomyolipoma, thorax, e.g. In: WHO Classification of Tumours Editorial Board. Soft-Tissue Lipomas: Accuracy of Sonography in Diagnosis with Pathologic Correlation. A 34-year-old woman who is 2years post-partum presented with a palpable left breast mass, diffuse breast swelling, tenderness, and erythema for several weeks. Pathol Res Pract 191(12):12221230, OHara MF, Page DL (1985) Adenomas of the breast and ectopic breast under lactational influences. T2-weighted sagittal images (e) show moderate T2 signal with marked heterogeneity (arrow). 6.35). It is defined as a . Longitudinal grayscale ultrasound (b) shows a large, oval circumscribed mass. In evaluating a soft tissue mass of the extremity, a differential diagnosis can be organized based on location of the mass and age of the patient, Examination technique is important when performing ultrasound of a soft tissue mass. Inampudi P, Jacobson J, Fessell D et al. also what is a heterogenous nodule with tiny cystic spaces, it measures 0.7cm? To date, there is no evidence that lymphocytic mastopathy is associated with an increased risk of developing lymphoma [22, 25]. Malignant fibrous histiocytoma or undifferentiated pleomorphic sarcoma is the most common soft tissue sarcoma. The third ultrasound appearance of liposarcoma occurs with high-grade or poorly differentiated tumors, and includes dedifferentiated, myxoid (if containing a round cell component), pleomorphic, and mixed subtypes. Elastofibroma dorsi is a benign fibroelastic pseudotumor, believed to result from friction between the scapula and chest wall. The echo pattern of breast lesions is categorized as anechoic, hypoechoic, isoechoic, or hyperechoic with reference to the subcutaneous fat in the American College of Radiology (ACR) BI-RADS [ 3 ]. Google Scholar, Going JJ, Anderson TJ, Wilkinson S, Chetty U (1987) Granulomatous lobular mastitis. These may represent areas of fat necrosis, fibrous tissue, blood vessels, or muscle fibers; these lesions cannot be confidently differentiated from liposarcoma by imaging. Additional history gained during the ultrasound examination often adds insight to narrow the differential diagnosis. Murphey M, Carroll J, Flemming D, Pope T, Gannon F, Kransdorf M. From the Archives of the AFIP: Benign Musculoskeletal Lipomatous Lesions. PubMed Central Mary S. Guirguis. The management of sclerosing adenosis ultimately relies once again on the imaging features. She did not have a history of diabetes or other known immunologic condition. J Orthop Sci. Non-mass enhancement has also been reported [31]. With regard to their . Extended field of view grayscale ultrasound (b) shows an ill-defined hypoechoic, irregular mass (arrows). In 5-15% of patients, lipomas are multiple, and ~33% of these will be familial 5. statement and Breast abscess is a complication of infectious mastitis. If all characteristics are those of a simple lipoma, and no local symptoms such as pain are present, then no treatment is generally required. In one study, PASH was seen in up to 23% of biopsied cases which reflects its wide spectrum of imaging findings [47]. The most common sites of metastasis are the lymph nodes and lungs. The area was palpable by the patient and the clinician. Other Conditions Medical test results can be hard to understand. Granulomatous mastitis typically presents as a firm palpable mass that is sometimes associated with skin erythema or pain [11]. 3e). Although leiomyomas are uncommon outside the uterus and gastrointestinal tract, they may be found in the extremities and take one of three forms: cutaneous leiomyoma (most common, located in the dermis), angioleiomyoma (located in the subcutaneous tissues), and leiomyoma of deep tissues. Created for people with ongoing healthcare needs but benefits everyone. Cancer 63(6):11541160, Jones KN, Glazebrook KN, Reynolds C (2010) Pseudoangiomatous stromal hyperplasia: imaging findings with pathologic and clinical correlation. This will stabilize the transducer, allow fine movements, and help to assess how much pressure is being placed with the transducer. A 36-year-old woman presented with a palpable breast mass. Granular cell tumor is an extremely rare tumor of neural origin. Craniocaudal and lateral spot compression views (a, b) show a small irregular mass with spiculated margins (arrows). On this longitudinal ultrasound view of a 10-year old child's neck a hypoechoic tract from the surface of the skin is demonstrated (arrows); this extended posteriorly towards the base of the tongue and appeared to move with protrusion of the tongue. Axial PET/CT (f) shows diffuse fluorodeoxyglucose avidity involving the left breast (arrow). On ultrasound, a hamartoma presents as a parallel mass with circumscribed margins and heterogonous echotexture due to variable amounts of fat and glandular tissue. 14) [66]. J Clin Pathol 40(5):535540, Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G (2009) Granulomatous lobular mastitis: imaging, diagnosis, and treatment. Insights into Imaging Possible additional descriptors include the following: . T1weighted axial delayed post-contrast (d) and sagittal subtraction (e) post-contrast MRI shows diffuse skin thickening (solid arrow) and trabecular thickening with heterogenous enhancement involving the left superior breast (dashed arrows). Most of these incidental liver masses in your age group, assuming no history of cancer, turn out to be benign, usually hemangiomas. Lipomas are benign fatty tumors. Additionally, MRI is better able to demonstrate the surrounding anatomy. 12g). isoechoic, i.e. Transverse grayscale (d) ultrasound reveals a corresponding oval isoechoic circumscribed mass. While a complete review of interventional techniques as they relate to soft tissue masses is beyond the scope of this chapter, several general points deserve emphasis. To date, only a single case of PASH with malignant transformation has been reported [52]. Lipomas appear as soft variably echogenic masses, commonly encountered on ultrasound. Nonpuerperal abscesses can pose a diagnostic challenge and are more commonly seen in younger women. Breast J 14(1):106, Nakazono T, Satoh T, Hamamoto T, Kudo S (2003) Dynamic MRI of fibromatosis of the breast. Your US state privacy rights, Often hypoechoic and peripheral zone lesions are the only areas sampled. If the sclerosing adenosis is associated with a radial scar, surgical excision is recommended. Radiology. The patients symptoms improved over the following 6months. 18 The key difference between biliary cystadenoma or biliary cystadenocarcinoma and a hemorrhagic or infected hepatic cyst is that the capsule, internal septations and mural nodules show . (WHO classification of tumours series, 5th ed. The main differential is: liposarcoma: low-grade tumors are difficult to differentiate from lipomas, and can have a relatively benign clinical course but suffer from a high rate of recurrence 1. Int J Epidemiol 17(4):810813, Rizzo M, Gabram S, Staley C et al (2010) Management of breast abscesses in nonlactating women. thymolipoma,elastofibroma dorsi, deep lipomatous masses should be assessed carefully, as they are more likely to be malignant and retroperitoneal fatty masses should be considered a well-differentiated liposarcoma until proven otherwise 5, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In cases of well-sampled architectural distortion, a short-term follow-up is recommended. Lymph node involvement in lymphoma has an appearance that it is consistent with malignant infiltration but is otherwise nonspecific, including enlargement, a round rather than oval shape, thickening of the node cortex, and narrowing or obliteration of the echogenic hilum.
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