Pathology
• Fibroadenoma
Management
• BI-RADS Assessment Category 3, probably benign; short-interval follow-up
Pearls and Pitfalls
Sonographically, if the mass has a well-defined margin, hyperechoic thin capsule, and no shadowing and is also homogeneously hypoechoic, then the chances of malignancy are very low (<5%). Since this mass represents a new palpable lump that has not been identified previously, we chose short-term follow-up to assess growth rate and stability of appearance. However, the patient chose to biopsy this lesion.
Suggested Readings
1. Cole-Beuglet C, Skoriano RZ, Kurtz AB, Goldberg BB. Fibroadenoma of the breast: sonomammographically correlated with pathology in 122 patients. AJR 1983;140:369–375.
2. Fornage BD, Lorigan JB, Andry E. Fibroadenoma of the breast: sonographic appearance. Radiology 1989;172:671–675.
3. Jackson VP, Rothschild PA, Kreipke DL, et al. The spectrum of sonographic findings of fibroadenoma of the breast. Invest Radiol 1986;21:34–40.
4. Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 1995;196:123–134.
Case 14
Case History
A 48-year-old woman presents with a new palpable right lump.
Physical Examination
• right breast: palpable lump at the 10:00 position
• left breast: normal exam
Mammogram
Mass (Fig. 14–1)
• margin: obscured
• shape: oval
• density: equal density
Figure 14–1. In the right upper outer quadrant, there is an oval mass (arrow) with obscured margins, which corresponds to the palpable lump demarcated with a metallic marker. (A). Right MLO mammogram. (B). Right CC mammogram.
Ultrasound
Frequency
• 13 MHz
Mass
• margin: well defined
• echogenicity: hypoechoic
• retrotumoral acoustic appearance: single edge shadowing
• shape: lobulated (Fig. 14–2)
Figure 14–2. Right antiradial breast sonogram: At the 10:00 position, there is a hypoechoic, lobulated mass that corresponds to the mass identified in Figure 14–1.
Pathology
• fibrocystic changes
• stromal hyalization, microscopic cysts, and apocrine metaplasia
Management
• BI-RADS Assessment Category 4, suspicious; biopsy should be considered
Pearls and Pitfalls
1. In retrospect, the sonographic appearance of the mass correlates well with the histology as small cysts are evident within the lesion.
2. Fibrocystic changes generally cause symptoms in premenopausal women. About 75% of affected women are in the fourth or fifth decade. Three clinical stages have been described. Initially, women note premenstrual breast swelling or pain. Later, they develop breast lumps. Finally, the period of breast tenderness becomes continuous throughout the menstrual cycle. After menopause, the symptoms wane. Although at autopsy 25% of women have fibrocystic changes, only 10% of women older than 60 years have symptoms.
Suggested Readings
1. Leis HP, Kwon CS. Fibrocystic disease of the breast. J Reprod Med 1979;22:291–296.
2. Tavassoli FA. Benign lesions. In: Tavasolli FA, Fattaneh A, eds. Pathology of the Breast. 2nd ed. Stamford: Appleton and Lange; 1999:115–204.
3. Vorherr H. Fibrocystic breast disease: pathophysiology, pathomorphology, clinical picture and management. Am J Obstet Gynecol 1986;154:161–179.
Case 15
Case History
A 65-year-old woman presents for her first mammogram.
Physical Examination
• normal exam
Mammogram
Mass (Fig. 15–1)
• margin: circumscribed
• shape: oval
• density: equal density
Figure 15–1. In the inferior medial left breast, there is an oval mass with a single round calcification. The spot compression view suggests that the margins are ill defined. (A). Left MLO mammogram. (B). Left CC mammogram. (C). Left MLO spot compression mammogram.
Ultrasound
Frequency
• 7.5 MHz
Mass
• margin: well defined
• echogenicity: heterogeneous
• retrotumoral acoustic appearance: posterior shadowing distal to mass
• shape: ellipsoid (Fig. 15–2)
Figure 15–2. Left radial breast sonogram: At the 8:00 position of the left breast there is a well-defined oval mass of heterogeneous (predominantly hyperechoic) echogenicity.
Pathology
• fibrocystic change
• hyalin sclerosis (fibrosis)
Management
• BI-RADS Assessment Category 4, suspicious; biopsy should be considered
Pearls and Pitfalls
1. The recommendation for biopsy is based on the mildly ill-defined mammographic margins and the mildly heterogeneous sonographic echogenicity.
2. When fibrocystic changes produce a circumscribed mammographic mass, the sonographic findings correspond to either a cyst or a focal solid mass. The sonographic appearance of a solid mass is variable and biopsy is generally required. The sonographic fibrocystic masses may be either well or ill defined. They may be hyperechoic, hypoechoic, or heterogeneous echogenicity.
Suggested Readings
1. Love SM, Gelman RS, Silen W. Fibrocystic “disease” of the breast—a non-disease. N Engl J Med 1982;307:1010–1014.
2. Teboul M, Halliwell M. Atlas of Ultrasound and Ductal Echography of the Breast. 2nd ed. Cambridge: Blackwell Science; 1996:106–110, 180–185.
3. Tohno D, Cosgrove DO, Sloane JP. Benign breast change.