Diabetic Mastopathy
This is an unusual form of benign proliferative mastopathy consisting in lobulitis,
lymphocitic infiltration and stromal fibrosis.
It typically occurs in premenopausal women with long standing type I diabetes mellitus.
Clinically patients present with solitary or multiple hard breast masses.
Mammography usually shows dense parenchima ( Fig 1) Ultrasound examination shows hypoecoic irregular masses with marked posterior acoustic shadowing (1,2) ( Fig 2)
Magnetic resonance examination usually shows no enhancement of the palpable areas.
Diagnosis by means of core needle biopsy is recommended.
Carbon Granulomas
Carbon granulomas are a foreign body reaction around carbon marker injected in breast localization procedures,
which was not completely removed during surgery.
Histologically in the early stages they consist in an inflamatory reaction with macrophages and giant cells which are later replaced by scar tissue containing inclusions of foreign body material.
Carbon granulomas can be palpable as hard moveable nodules or may be found during a mammogram examination.
Radiologically present as dense,
often spiculated nodules localized in scar tissue,
where carbon injection was made.
(3) ( Fig 3) Ultrasound shows irregular or spiculated nodules with acoustic shadowing ( Fig 4) which cannot be differenciated from carcinomas.
(3) Biopsy procedures yield dark tissue,
characteristic of the material injected ( Fig 5)
Pseudoangiomatous Stromal Hyperplasia (PASH)
Pseudoangiomatous stromal hyperplasia is a benign proliferation of breast stromal cells which was first described in 1986 as an uncommon palpable breast mass in premenopausal women.
Nowadays it is less commonly found as a clinically palpable mass and is more commonly found as incidental microscopic foci.
Histologically,
PASH must be differenciated form low-grade angiosarcomas and phyllodes tumors.
Clinically PASH may be palpable and may resemble fibroadenomas.(4) Radiologically
PASH can present as a well circumscribed mass ( Fig 6) or an irregular,
ill-defined nodule.
Ultrsound may show a well circumscribed nodule ( Fig 7) or an irregular mass with acousting shadowing(5). (Fig 8).
In the appropiate clinical setting a core biopsy yielding PASH is enough and allows imaging follow-up.
Granular cell tumor (GCT)
Granular Cell Tumor is an unusual neoplasm derived from Schwann cells,
that may arise in many body sites.
The most common location is the oropharynx,
followed by striated muscle bundles and skin.
Breast localization is exceptional and accounts for 6-8% of all GCTs.(6) Knowledge of this tumor is important: when it affects the mammary parenchima can simulate malignancy both clinically and radiologically.
Tumor cells have a typical granular appearance due to accumulation of secretory granules and lysosomes.
They stain positive for S-100 protein and negative for cytokeratin.
Mammograms show ill-defined or spiculated nodules with no associated microcalcifications ( Fig 9,
10.
Ultrasound shows ill-defined masses with acoustic shadowing.
Sometimes an hyperecoic halo may be present.(7) ( Fig 11)
Clinically this tumors may cause skin retraction,
and when deeply located may be fixed to the pectoral muscle.
Core needle biopsy is needed to establish a correct diagnosis.
CGTs are treated with wide local excision.
Sclerosing Adenosis:
This is a proliferative lesion included in the so-called fibrocystic changes caused by combination of adenosis and stromal sclerosis.
As a result the hyperplastic mammary lobules become irregular and distorted. Mammographical appearances include pleomorfic microcalcifications,
circumscribed masses,
masses with ill-defined margins or spiculation and architectural distortion.(8) ( Fig 12)
On US,
this entity may present as a circumscribed nodule,
an area of focal acoustic shadowing,
or a s an irregular mass with or without acoustic shadowing.
Radial Scar (RS):
This is a benign entity presenting as a spiculated mass or focal distortion which cannot be distingushed from a breast carcinoma by means of imaging studies.
Radiologically it presents as a spiculated mass or distortion with long radiating spicules and a discrete or radiolucent center.(9) (Fig 13 ) It
often has a varying appearance in the orthogonal mammographic projections due to its planar configuration. On US it is seen as an irregular,
hypoecoic mass.
Histologically it consists of a central fibroelastic core and radiation of ducts and lobules,
which may show papillomatosis,
hyperplasia,
cyst formation and adenosis. RS may be associated with tubular carcinomas and ductal carcinoma in situ.
Hence,
to allow a correct diagnosis excisional biopsy of the entire lesion is recommended.
Fat Necrosis (FN):
Fat necrosis of the breast is a nonsuppurative benign inflamatory process which may occur as a result of trauma or surgery.
It can be seen after blunt trauma,
percutaneos biopsy,
reduction mammoplasty,
breast-conserving surgery and autologous tissue reconstructive surgery,
though in some cases no specific cause is identified.
It presents with imaging features and clinical signs that may simulate breast cancer.
FN may present as a mammographic finding in asymptomatic patiens or as a painless breast lump.
Imagin studies may show a classical oil-cyst (Fig 14,
15) a round density or an irregular spiculated density (Fig 16,
17,
18.
Microcalcifications are ususally present which may be coarse or fine and pleomorfic.(10)
On US fat necrosis may appear as a complex cystic mass,
a solid nodule or as increased echogenicity of the subcutaneous tissues.(11)