# Case 1
A 34- year-old woman with sudden enlargement of the both breasts for 6 months and a palpable lump in the left axilla
<Differential diagnosis>
1.
Pseudoangiomatous stromal hyperplasia (PASH) ?
2. Multiple fibroadenomas ?
3. Phyllodes tumor ?
4. Multiple giant hamartomas ?
Confirm diagnosis by surgery : Hamartoma in both breasts and left axilla
<Hamartoma>
'Breast within a breast”
Uncommon benign disease of the breast accounting 4.8%
Mean age of patients : 41.8 years
Size : 0.9 ~ 6.9cm
Tumor can develop to a larger size and may be painful
Imaging findings
- Well-circumscribed mass containing fat and glandular tissue
# Case 2
A 15-year-old girl with non-tender palpable lump in right breast
Patient reported that the mass had been smaller one year ago and abruptly enlarged recently.
No history of pregnancy,
lactation,
infection,
trauma to the breast
Confirm diagnosis by surgery : Infarcted fibroadenoma
<Infarcted fibroadenoma>
Cause of infarction
•Pregnancy
•Lactation
•Recent fine-needle aspiration
•Spontaneous infarction (extremely rare!)
Pathologic findings
•Central necrosis (extensive coagulation necrosis)
Radiologic findings
•Complex cystic and solid mass
# Case 3
A 33-year-old woman with non-tender palpable hard lumps in both breasts
Insulin-dependent DM (type 1) for 17 years
Confirm diagnosis by US-guided core needle biopsy : Diabetic mastopathy
<Extensive mastitis>
Immunologic diseases
•Diabetic mastopathy
•Sarcoidosis
•Wegener’s granulomatosis
Specific infections
•Mycobacterium tuberculous mastitis
Inflammatory diseases of unknown origin
•Granulomatous mastitis
<Diabetic mastopathy>
Benign masses in patients with long-standing diabetes (13% of patients)
Pathology : only by core needle biopsy,
not FNA!
•Perilobar and perivascular lymphocytic infiltrate of mature B cells accompanied by intense keloid fibrosis
Imaging findings
•Ill-defined masses or asymmetry on mammography
•Irregular hypoechoic masses with posterior shadowing on sonography
•Variable findings on MRI
# Case 4
A 89-year-old woman with enlargement of left breast with skin change
Acute renal failure and rhabdomyolysis
<Differential diagnosis>
1.
Unilateral breast edema ?
2.
Inflammatory breast cancer ?
Diagnosis by patient's history and imaging : Breast edema by non-mammary origin
<Breast edema by non-mammary origin>
Congestive heart failure
•Unilateral breast edema by tendency to lie on one side
End stage of renal disease
Central vein occlusion (superior vena cava,
subclavian vein)
Arteriovenous fistular obstruction
Lymphatic obstruction due to lymphadenopathy
# Case 5
A 50-year-old woman with breast enlargement and skin discoloration for 6 months,
without nipple discharge
<Differential diagnosis>
1.
Papillary carcinoma ?
2.
Locally advanced IDC with necrosis ?
Confirm diagnosis by surgery : Benign intraductal papilloma with epithelial hyperplasia
# Case 6
A 49-year-old woman with rapid onset of skin erythema and palpable lump for 2 months
Confirm diagnosis by core needle biopsy : Invasive ductal carcinoma (basal-like type)
<Inflammatory breast cancer>
“Peau d’orange” (“Skin of an orange”)
Rare subtype of breast cancer (2-5%)
Clinical presentation
•Rapid onset of symptoms within 3 months
•Breast erythema and edema without palpable mass
# Case 7
A 52-year-old woman with rapid onset of palpable lump for 1 week
Confirm diagnosis by surgery : Malignant phyllodes tumor
<Malignant phyllodes tumor>
Giant phyllodes tumor >10cm in diameter
Clinical findings
•Sudden increase in size in a long-standing breast lesion
•Age : 45-49 years
•Malignant rate : 23-50%
Imaging findings
•Well circumscribed mass with solid and cystic portion
•Axillary LNs : Rare (2%)
# Case 8
A 64-year-old women with enlargement of left breast and pain
Confirm diagnosis by core needle biopsy : Invasive lobular carcinoma (basal-like type)
<Invasive lobular carcinoma>
Second most common breast cancer (10%)
Pathology
•Arising from the lobular epithelium
•Insidious onset
Imaging findings
•Frequently not apparent
•Usually detected at a later stage
# Case 9
A 54-year-old woman with palpable lumps in both breasts for 1 week
Past history of gastric cancer (signet ring cell) 6 years ago and Krukenberg tumors (arrows) in both ovaries
Confirm diagnosis by core needle biopsy : Metastatic carcinoma,
from stomach cancer
<Metastasis>
0.3~2.7% of all breast malignancy
Melanoma(m/c),
lymphoma,
lung,
ovary,
kidney,
stomach (signet-ring cell carcinoma [66%]),
oropharynx,
and carcinoid
Mean age : 45.5 years
# Case 10
A 35-year-old woman complaint of diplopia in her left eye and palpable lumps in both breasts
Diagnosed with primary extramedullary plasmacytoma of epidural mass at the level of C6-T1 spines
Confirm diagnosis by core needle biopsy : Multiple myeloma
<Multiple myeloma>
Plasmacytoma
•Malignant plasma cell proliferative disorder derived from B cells in bone marrow
•Secondary to disseminated multiple myeloma
Breast plasmacytoma - extremely rare (1.5%)
•Round or oval masses with well-,
or ill-defined margin
•Hypoechoic,
ill-defined masses with hypervascularity
Take Home Messages
<Benign diseases>
1.
Giant hamartoma
2. Fibroadenoma with infarction
3. Diabetic mastopathy
4. Diffuse breast edema caused by non-mammary origin
5. Giant intraductal papilloma
<Malignant diseases>
1. Inflammatory carcinoma
2. Malignant phyllodes tumor
3. Invasive lobular carcinoma
4. Metastasis
•Signet ring cell gastric cancer
•Multiple myeloma