Oil Cyst Mimicking Intracystic Neoplasm

Oil Cyst Mimicking Intracystic Neoplasm
Sebnem Orguc, Isıl Basara, Teoman Coskun, Ali Rıza Kandiloglu
The Breast Journal
Volume 15 Issue 5, Pages 542 - 543

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Oil cysts are benign breast masses. Mammographically, oil cysts typically appear as well defined, round or ovoid masses, often with a calcified rim (eggshell calcification).

Sonographically, oil cysts may present in a variety of ways. Most cysts are anechoic or hypoechoic with a variable degree of posterior shadowing or acustic enhancement with a thin capsule. However, oil cysts presenting with mural nodules may rarely mimic intracystic neoplasm and ultrasound cannot characterize the masses as benign.

Mammograms which demonstrate the fatty content are diagnostic.

Calcification of Breast Tissue in the Ehlers–Danlos Syndrome

Calcification of Breast Tissue in the Ehlers–Danlos Syndrome
Elizabeth Tapley, Peter Beighton
The Breast Journal
Volume 15 Issue 5, Pages 537 - 539

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The practical significance of breast tissue calcification in the EDS lies in the importance of awareness of this association, in the context of routine mammographical screening of carcinoma for the breast

MR Imaging of Tubular Adenoma of Breast Associated with Lactating Change

MR Imaging of Tubular Adenoma of Breast Associated with Lactating Change
Mariko Goto, Sachiko Yuen, Tsunehiko Nishimura
The Breast Journal
Volume 15 Issue 5, Pages 536 - 537

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Specimen Radiographs Assist in Identifying and Assessing Resection Margins of Occult Breast Carcinomas

Specimen Radiographs Assist in Identifying and Assessing Resection Margins of Occult Breast Carcinomas
Erik Scott Young, David E. Hogg, Helen Krontiras, Wanda Bernreuter, Marshall Urist, Kirby I. Bland, David C. Chhieng
The Breast Journal
Volume 15 Issue 5, Pages 521 - 523

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For carcinoma specimens with non-grossly identifiable lesions such as microcalcifications, difficulties may be encountered in locating these abnormalities and sampling the margins that are at risk. This is magnified in the case of skin-sparing procedures where the margin is a much greater surface area and is the operation of choice in patients with diffuse microcalcifications and/or multifocal in situ disease. The objective of this study was to determine the efficacy of specimen radiographs of mastectomy in identifying occult carcinoma associated with microcalcifications and assessing the resection margins.

The average number of tissue blocks sampled among randomly selected mastectomy specimens was 15.2 ± 5.4. There was no statistically significant difference in the number of blocks between mastectomy cases with specimen radiographs taken and those without (t-test). Our study suggests that specimen radiographs may assist in identifying occult breast carcinoma associated with microcalcifications and assessing the resection margins without increased sampling

Breast Hamartomas in Adolescent Females

Breast Hamartomas in Adolescent Females
Henry L. Chang, Melinda F. Lerwill, Allan M. Goldstein
The Breast Journal
Volume 15 Issue 5, Pages 515 - 520
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Breast hamartomas are rare in the adolescent population. The clinical and radiographic features are similar to the more common fibroadenoma, but the pathologic findings are diagnostic. Recurrence can occur if excision is incomplete.

Increased recognition and accurate diagnosis will improve our understanding of the natural history of these lesions

Use of Ultrasound-Guided Percutaneous Vacuum-Assisted Breast Biopsy for Selected Difficult Indications

Use of Ultrasound-Guided Percutaneous Vacuum-Assisted Breast Biopsy for Selected Difficult Indications
Sylvia H. Heywang-Köbrunner, Anke Heinig, Karin Hellerhoff, Hans Jürgen Holzhausen, Jörg Nährig
The Breast Journal 15;4:348-356

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To assess ultrasound-guided vacuum-assisted biopsy (US-VAB) for selected problem cases and to report experiences with two different biopsy systems. Fifty-one lesions have been biopsied using the Mammotome (n = 24) or the Vacora (n = 27) system.

Main indications: lesion in scarring (n = 5), complex cystic ≥8 mm (n = 7), increase in size (n = 10), architectural distortion (n = 4), uncharacteristic palpable abnormality (2), small size (n = 22), regional microcalcifications (n = 1). Results are verified by surgical excision (n = 10) or follow-up (n = 40). One patient was lost to follow-up. In four of the cases preceding core biopsy was inconclusive. four invasive carcinomas, two ductal carcinoma in situ (DCIS), three papillomas, six fibroadenomas, one adenosis tumor, one hamartoma, 10 complex cysts, 16 benign changes, three fat necroses, two granulomas, three unspecific inflammatory changes are verified.

Surgery confirmed five malignancies, four benign changes, and converted one uncertain diagnosis (architectural distortion) from "inflammatory" to DCIS. Documented removal of all or most of the lesions correctly increased the level of confidence and open surgery could be avoided in 41/51 lesions.

The two systems show different advantages and drawbacks. US-VAB may improve the level of confidence in selected difficult cases. Careful case selection and systematic retrospective correlation of imaging and histology remain crucial

Correlation between Quantified Breast Densities from Digital Mammography and 18F-FDG PET Uptake

Correlation between Quantified Breast Densities from Digital Mammography and 18F-FDG PET Uptake
Paras Lakhani, Andrew D. A. Maidment, Susan P. Weinstein, Justin W. Kung, Abass Alavi
The Breast Journal 15;4:339-347

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To correlate breast density quantified from digital mammograms with mean and maximum standardized uptake values (SUVs) from positron emission tomography (PET). This was a prospective study that included 56 women with a history of suspicion of breast cancer (mean age 49.2 ± 9.3 years), who underwent 18F-fluoro-2-deoxyglucose (FDG)-PET imaging of their breasts as well as digital mammography. A computer thresholding algorithm was applied to the contralateral nonmalignant breasts to quantitatively estimate the breast density on digital mammograms. The breasts were also classified into one of four Breast Imaging Reporting and Data System categories for density.

Comparisons between SUV and breast density were made using linear regression and the Student's t-test. Linear regression of mean SUV versus average breast density showed a positive relationship with a Pearson's correlation coefficient of R2 = 0.83. The quantified breast densities and mean SUVs were significantly greater for mammographically dense than nondense breasts

The average quantified densities and mean SUVs of the breasts were significantly greater for premenopausal than postmenopausal patients

Menopausal status affects the metabolic activity of normal breast tissue, resulting in higher SUVs in pre- versus postmenopausal patients

A Case of Benign Schwannoma of the Breast: Mammographic, Ultrasonographic and Color Doppler Ultrasonographic Findings

A Case of Benign Schwannoma of the Breast: Mammographic, Ultrasonographic and Color Doppler Ultrasonographic Findings
Pinar Balci, Yeliz Takes Pekcevik, Sehnaz Caferova, Tulay Canda, Ali Sevinc, Serdar Saydam
The Breast Journal 15;4:417-418

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Most primary tumors of the breast have an epithelial origin. Nonepithelial tumors arising from indigenous structures in the breast are rare. Schwannoma (neurilemoma) is a benign neoplasm of Schwann cell origin. It can be observed anywhere in the body but the breast is a very unusual site for this tumor.

Schwannoma is a slow growing tumor, usually solitary and it appears as a breast lump having clinical and radiologic characteristics suggestive of benign lesions. Its diagnosis is histologic and its treatment is surgical

Primary Leiomyosarcoma of the Breast

Primary Leiomyosarcoma of the Breast
Bengu Cobanoglu, Muge Sezer, Pervin Karabulut, Sirin Ozer, Ayse Murat
The Breast Journal 15;4:423-425

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Lobulated mass without microcalcification

Barium Sulphate Particles in Breast Mimicking Malignant Type Microcalcification

Barium Sulphate Particles in Breast Mimicking Malignant Type Microcalcification
Louise Bamford, Tong F. Lioe, Declan M. O'Rourke, Miriam R.E. Buckley
The Breast Journal 2009 15; 3: 305-306

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Because of its radiopaque properties, barium sulphate has long been used impregnated into wound dressings, making it visible on X-ray, a useful identifying tool in cases of misplaced dressing materials. It is most likely that the barium sulphate was introduced into the breast from wound dressing materials at the time of previous abscess drainage. Although various materials have been described mimicking microcalcification on mammogram, as far as we are aware, there are no other reports in the literature identifying barium sulphate as the culprit foreign body material in the breast, mimicking malignant type microcalcification on mammogram.

Foreign body materials within breast can mimic sinister pathology. Such mimics, especially in patients where previous intervention has been performed, presented to the unwary, can prompt extensive further investigation, with resultant significant impact on patient management, patient anxiety, and healthcare resources. We must be aware of this potential pitfall

Unilateral Calcifying Lupus Mastitis in a Male Breast

Unilateral Calcifying Lupus Mastitis in a Male Breast
Jeroen Crevits, Andreas Van Steen, Chantal Van Ongeval, Guy Marchal
The Breast Journal 2009 15; 3: 307-308

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Lupus mastitis consists of subcutaneous nodules or plaques, with or without epidermal manifestations, usually leaving persistent areas of lipoatrophy. Those which tend to undergo necrosis may be associated with areas of dystrophic calcification. In men without gynecomastia calcifications can only be due to fat necrosis, that may be extensive in case of lipomastia. Differential diagnosis of lupus mastitis includes breast carcinoma, nonHodgkin lymphoma, uncommon breast localizations of connective tissue and systemic diseases. The dystrophic calcifications in our case were easily differentiated from calcifications indicating malignancy. In fact, these mammographic findings could also be due to silicon injections or posttraumatic fat necrosis, but interrogation rejected these hypotheses.

Lupus mastitis is a subset of lupus panniculitis limited to the breast. It is a rare inflammatory reaction of the subcutaneous fat, that may occur in 2–3% of patients with SLE. Lupus mastitis can be suspected in patients with SLE presenting with breast masses involving the subcutaneous fat. However, it is important that any suspicious calcifications and masses should be well examined to exclude malignancy

"Cholesteroloma": A Rare Cause of "Indeterminate" Microcalcifications on Mammography

"Cholesteroloma": A Rare Cause of "Indeterminate" Microcalcifications on Mammography
Michael A. Seidman, Theresa Scognamiglio, Syed A. Hoda
The Breast Journal 2009 15; 3: 303-304

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"Cholesteroloma" forms when ectatic ducts rupture releasing luminal debris, histiocytes, and cholesterol and/or its precursors into breast stroma. Cholesterol is the principal component of this mass—hence the term "cholesteroloma."

Calcifying Fibrous Pseudotumor of the Breast

Calcifying Fibrous Pseudotumor of the Breast
Amrit Mangat, Carol Schiller, Patricia Mengoni, Carol Reynolds, Jacqueline S. Jeruss
The Breast Journal 2009 15; 3: 299-301

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Calcifying fibrous pseudotumor (CFP) is classified as a benign fibrous lesion, and is a rare pathologic entity. Previous reports have described CFPs in the extremities, chest wall, pleura, scrotum, mediastinum, neck, and visceral peritoneum. We present the first reported case of a CFP in the breast. CFP should be considered in the differential diagnosis for patients presenting with coarse indeterminate calcifications of the breast

Fiberoptic Ductoscopy-Guided Intraductal Biopsy Improve the Diagnosis of Nipple Discharge

Fiberoptic Ductoscopy-Guided Intraductal Biopsy Improve the Diagnosis of Nipple Discharge
Hong Ling, Guang-yu Liu, Jin-song Lu, Susan Love, Jia-xin Zhang, Xiao-li Xu, Wei-ping Xu, Kun-wei Shen, Zhen-zhou Shen, Zhi-min Shao
The Breast Journal 15 ( 2): 168 - 175

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Fiberoptic ductoscopy (FDS)-guided intraductal biopsy is a minimally invasive technique developed to obtain pathologic diagnoses for patients with spontaneous nipple discharge.

We performed biopsies of 53 intraductal lesions from March 2006 to April 2007 followed by surgical microdochectomy. FDS-guided intraductal biopsy was shown to be a minimally invasive, safe, and convenient technique with a high ability (90.6%) to get adequate samples. Twenty-seven solitary papillomas, 12 multiple intraductal papilloma, five ductal hyperplasia, three ductal carcinoma in situ, and one invasive ductal carcinoma were diagnosed.

Compared with conventional microdochectomy, FDS-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma (40.7% versus 92.6%, p <>

Fiberoptic Ductoscopy-Guided Intraductal Biopsy Improve the Diagnosis of Nipple Discharge
Hong Ling, Guang-yu Liu, Jin-song Lu, Susan Love, Jia-xin Zhang, Xiao-li Xu, Wei-ping Xu, Kun-wei Shen, Zhen-zhou Shen, Zhi-min Shao
The Breast Journal, Volume 15 Number 2, 2009 168–175

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Fiberoptic ductoscopy (FDS)-guided intraductal biopsy is a minimally invasive technique developed to obtain pathologic diagnoses for patients with spontaneous nipple discharge.

We performed biopsies of 53 intraductal lesions from March 2006 to April 2007 followed by surgical microdochectomy. FDS-guided intraductal biopsy was shown to be a minimally invasive, safe, and convenient technique with a high ability (90.6%) to get adequate samples. Twenty-seven solitary papillomas, 12 multiple intraductal papilloma, five ductal hyperplasia, three ductal carcinoma in situ, and one invasive ductal carcinoma were diagnosed.

Compared with conventional microdochectomy, FDS-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma (40.7% versus 92.6%, p < 0.05). It should be a routine procedure after intraductal lesion found by screening FDS.

Since it would underestimate all multiple intraductal papilloma and some (50%) cancer, microdochectomy is inevitable if biopsies show atypical ductal hyperplasia

Early Detection of Breast Cancer through Population-Based Mammographic Screening in Asian Women: A Comparison Study between Screen-Detected and Sympto

Early Detection of Breast Cancer through Population-Based Mammographic Screening in Asian Women: A Comparison Study between Screen-Detected and Symptomatic Breast Cancers
Esther W. L. Chuwa, Allen W. Y. Yeo, Heng Nung Koong, Chow Yin Wong, Wei Sean Yong, Puay Hoon Tan, Juliana T. S. Ho, Jill S. L. Wong, Gay Hui Ho
The Breast Journal, Volume 15 Number 2, 2009 133–139

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Screening mammography has allowed the detection of smaller and hence oncologically more favorable lesions in Asian women. Although no significant survival benefit was demonstrated in our study, a longer period of follow-up is essential before the benefit of mortality reduction, as a result of mammography screening becomes evident in our population

Breast MRI in a Case of "Early Onset" Lactating Adenoma

Breast MRI in a Case of "Early Onset" Lactating Adenoma
Stefano Magno, Daniela Terribile, Gianluca Franceschini, Cristina Fabbri, Pierfrancesco D'Alba, Federica Chiesa, Alba Di Leone, Melania Costantini, Paolo Belli, Riccardo Masetti
The Breast Journal, Volume 15 Number 1, 2009 105–106

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Care report with images

The Importance of Preoperative Breast MRI for Patients Newly Diagnosed with Breast Cancer

The Importance of Preoperative Breast MRI for Patients Newly Diagnosed with Breast Cancer
Joseph P. Crowe, Rebecca J. Patrick, Alice Rim
The Breast Journal, Volume 15 Number 1, 2009 52–60

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The findings here of one community hospital's experience (13% upgrade to mastectomy rate) conflict with the COMICE Trial results