The evaluation of 103 mammographies where solitary dilated duct were identifying had the second look ultrasound performed to confirm the presence of SDD and evaluating the intraductal content.
Follow up,
some of that with heterogeneous content had anatomopathological study performed by core biopsy US-guided or surgery.
Case 1 - FALSE POSITIVE MAMMOGRAPHY (Fig.1)
Ocasionally,
solitary dilated duct visualized by mammography can not be confirmed by US second look.
Prior surgery or other mammary parenchyma changes can mimetize a solitary dilated duct at mammography.
CLINICAL FEATURES: 78 years-old,
screening mammogram.
No breast cancer risk factors.
MAMMOGRAPHY: SDD identified by high density at retroareolar area on the left breast.
ULTRASOUND: no SDD at retroareolar area.
Case 2 – PAPILLOMA (Fig.2)
Intraductal papilloma is the most common papillary lesion and it can be classified as central or peripherical,
depending on the mammary localization.
The papilloma related with SDD is the central one and shows a single intraductal lesion.
CLINICAL FEATURES: 56 years-old,
screening mammogram.
No breast cancer risk factors.
MAMMOGRAPHY: SDD identified by high density at retroareolar area on the right breast associated with round calcifications.
ULTRASOUND: SDD shows hypoechoic intraductal content and high elastography.
ANATOMOPATHOLOGICAL RESULT: papilloma,
confirmed by lumpectomy surgery.
Case 3 - FIBROADENOMA (Fig.3)
Fibroadenoma is the most common benign mass in women’s breast.
There is no specific localization and the follow-up generally is sufficient.
CLINICAL FEATURES: 69 years-old,
screening mammogram.
No breast cancer risk factors.
MAMMOGRAPHY: SDD identified by high density at retroareolar area on the left breast.
ULTRASOUND: oval,
parallel,
circumscribed,
heterogenous intraductal mass at retroareolar area,
high elastography.
ANATOMOPATHOLOGICAL RESULT: fibroadenoma.
Case 4: DUCTAL ECTASIA (Fig.4)
Ductal ectasia is mostly common in women after menopause.
It presents an anechogenic intraductal content without malignancy suspect.
CLINICAL FEATURES: 62 years-old,
screening mammography.
No personal or family history of breast cancer.
MAMMOGRAPHY: SDD identified by high density at retroareolar area on the left breast.
ULTRASOUND: dilated duct with homogeneous content retroareolar area.
ANATOMOPATHOLOGICAL RESULT: not performed
Case 5 - INVASIVE BREAST CANCER (Fig.5)
Suspicious mass can present associated findings able to make more malignant suspicious.
For instance,
thin retraction,
inflammatory signs,
and dilated duct,
generally are secondary of the essential mass.
CLINICAL FEATURES: 63 years-old,
screening mammography.
No breast cancer risk factors.
MAMMOGRAPHY: spiculated mass,
high density at the union of laterals quadrants of left breast.
SDD identified by high density at the retroareolar area.
ULTRASOUND: irregular,
hypoechoic mass associated to dilated duct and high elastography.
ANATOMOPATHOLOGICAL RESULT: invasive breast cancer.