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Transcript of Mrozin md BENIGN MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta...
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mrozin md
BENIGN MASSES IN BREAST ULTRASOUND
Dr. Mona RozinDirector of Breast Imaging
Assuta Medical Centers
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mrozin md
Benign MassesI. FibroadenomaII. Fibroadenoma variants : complex FA
tubular adenoma, lactating adenoma
III. Phylloides TumorIV. HamartomaV. LipomaVI. Focal FibrosisVII. Diabetic mastopathyVIII.Fibrocystic change
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mrozin md
I. Fibroadenoma
• Arise from a single TDLU and contain both stromal (fibroma) & epithelial (adenoma) elements
• Edge is “pushing” not infiltrating &
becomes “encapsulated” by compressed breast tissue
• FAs with cysts, apocrine metaplasia, or sclerosing adenosis are called COMPLEX
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mrozin md
FA – cont.
• Peak incidence – 20-30 yr & again 40-50 yr
• Usually 2-3 cm but giant FA & juvenile FA can grow to 10 cm
• Estrogen stimulation is important so most common when unopposed (anovulatory) i.e.. in adolescence and perimenopause
• Multiple in 25% also bilateral
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mrozin md
FA – sonographic appearance
• Oval, lobulated • Circumscribed with echogenic capsule• Parallel • Iso or hypoechoic• Normal or enhanced transmission with
edge shadows• Tiny ones (<1cm) may be round &
can’t DD from a complex cyst• May mimic duct extension
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mrozin md
oval
lobulated
irregular
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mrozin md
isoechogenic
hypoechogenic
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mrozin md
Calcifications in FA
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mrozin md
Ca++
FA in pathology
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mrozin md
FA – cont.
• Wide variability in histologic composition• Wide variability in sonographic
appearance
• Bilateral multiple FAs up to 10 nodules in each breastno need to Bx all of themnew ones will almost always developneed 6 mo. F/U
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mrozin md
II. FA variants – Complex FA
• The epithelial components undergo proliferative change and we may see:sclerosing adenosis, cysts, apocrine metaplasia, amorphous calcifications
• About 20% of all FAs are complex !(-) FHx increases risk for CA 3x (+) FHx increases risk for CA 4x
• Risk is generalized for the whole of both breasts.
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mrozin md
II. FA variants – Complex FA
• The diagnosis is histological • U/S: may see internal cysts or
heterogeneous echo pattern • Seen at older age – median age 47 yrs• Only 1.5% contained a CA
AJR:2008;190:214-218
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mrozin md
Complex
FAs
cysts & sclerosis
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mrozin md
II. FA variants – Tubular Adenoma & Lactating
Adenoma
• Almost pure epithelial growth with very little or NO stromal component
• Tubular adenoma is very rare• Lactating adenoma is common
during pregnancy (mainly 3rd trimester) and lactation
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mrozin md
II. FA variants – Tubular Adenoma & Lactating
Adenoma
• Lactating adenoma may arise de novo, from a FA or from a tubular adenoma
• U/S: oval, spindle shaped, parallel, hypo-hyperechoic, enhancement, Doppler (+), microlobulated
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mrozin md
spindle shaped
microlobulated
Tubular adenomas
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mrozin md
hyper
hypo
IDC-Grade 3
Lactating adenomas
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mrozin md
III. Phylloides Tumor
• Rare – peak at 40-50 yr but can occur in teenagers
• Very rapid growth – up to 15 cm• 2/3 benign 1/3 malignant• Mix of very cellular stromal and
epithelial elements • U/S: oval, well circumscribed,
capsule, hypo, enhancement, “cystic slits”
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mrozin md
Phylloides with cystic clefts
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mrozin md
The faces of phylloides
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mrozin md
IV. Hamartoma
• Localized overgrowth of fibrous, epithelial and fatty elements = normal breast tissue
• Other names: adenolipofibroma, lipoadenofibroma, fibroadenolipoma
• U/S: oval, very heterogeneous, capsule, parallel
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mrozin md
Classic hamartoma
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mrozin md
Hamartoma on mammo & CT
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mrozin md
V. Lipoma
• Overgrowth of fatty tissue• They are actually in the skin NOT in
the breast • May grow up to 20 cm !!!!
• U/S: completely isoechoic with the other fat lobules or mildly hyperechoic, soft and compressible
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mrozin md
hyper
iso
fat necrosis
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mrozin md
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mrozin md
VI. Focal Fibrosis
• FIBROUS MASTOPATHY
• Can cause tender/non-tender palpable lump
• May see focal asymmetry on mammo – UOQ
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mrozin md
VI. Focal Fibrosis
• Pathology: dense stromal fibrous tissue without cells
• U/S: purely hyperechoic & homogeneous,
no capsule tapers into Cooper’s ligaments so can be teardrop or spindle shaped
BEWARE: DD with echogenic rim !!!
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mrozin md
MUST have mammographic correlation
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mrozin md
VII. Diabetic Mastopathy
• Occurs in premenopausal women • Most have Type I diabetes before
the age of 20 yr
• Usually a very hard palpable lump• May be multifocal, multicentric
and bilateral
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mrozin md
VII. Diabetic Mastopathy
• Mammo: non specific asymmetry
• U/S: VERY SCARY !!!!!! Ill-defined, angular, microlobulated, hypoechoic, not parallel, intense shadowing
• ALL go to Bx.
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mrozin md
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mrozin md
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mrozin md
VIII. Fibrocystic Change• Huge spectrum from all the types of
cystic change to benign proliferation forming a solid nodule
• Adenosis & Sclerosing Adenosis:TDLUs enlarge and increase in numbernormal lobules – 2 mmadenosis – 5 mm
• Mammo: focal asymmetry, masses, “starry night” calcifications
• U/S: extremely varied
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mrozin md
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mrozin md
adenosis with cysts
hypoechoic adenosis in hyper glandular tissue
adenosis with amorphous ca++
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mrozin md
Adenosis and blunt duct adenosis
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mrozin md
adenosis
blunt duct adenosis
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mrozin md
“starry night” of sclerosing adenosis
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mrozin md
The faces of sclerosing adenois
distended terminal lobule
branching
central fibrosis
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mrozin md
Sclerosing adenosis with spiculation & halo
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mrozin md
Sclerosing adenosis with ca++
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mrozin md
• Remember algorithm and technique
• Know your anatomy
• Must correlate with mammo & clinical presentation
• Huge overlap of findings
• Better than doing mammograms all day!
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mrozin md