Case 1:

A 74-years-old female patient who underwent breast core biopsy at the another medical centre because of a palpable mass in her left breast was referred to our clinic for ultrasonography(US) and mammography.

The mammography showed a mass with irregular defined border with a small number of microcalcifications in the lower inner quadrant of the left breast(Figure1).

In the lower inner quadrant of the left breast a homogeneous, hypoechoic, solid mass with irregular borders was detected on sonography(Figure2). The lesion was classified as category 5, highly suggestive of malignancy, on the basis of the Breast Imaging Reporting and Data System(4). Also US showed another hypoechoic milimetrically area near the mass. There was a pseudoanuresym and Color Doppler sonography revealed the presence of blood flow in pseudoaneursym that at the biopsy tract(Figure3). 

An associated adjacent artery was connected to the cavity by a track of pseudoaneursym(Figure3).

Partial mastectomy was performed in the patient who had an invasive lobular carcinoma result of the core biopsy and the pseudoaneurysm was surgically removed during the same operation.

Case 2:

A 45-years-old female patient had a 1 cm diameter asymmetric opacity in the upper outer quadrant of the left breast by annual routine mammography(figure4).

Ultrasonography showed 1cm diameter solid mass with irregular margins near the areola(figure5). The lesion was classified as category 4C, high suspicion for malignancy, on the basis of the Breast Imaging Reporting and Data System(4). Ultrasound-guided core biopsy was performed using a 14-gauge cutting needle(figure6). Core biopsy result was invasive apocrine carcinoma, mucinous adenocarcinoma and carcinoma with signet-ring cell differantiation.

3 weeks later after the biopsy, surgery was planned and patient send us for marking malign solid mass’s projection form the skin with US guiding. On US there was a hypoechoic 6 mm diameter nodular lesion at the biopsy tract(figure7).

Use of color flow(figure8,9) and pulsed doppler demonstrated chaotic blood flow within the centre of the lesion and high velocity antegrade and retrograde flow through a narrow vascular channel connecting it to an adjacent arterial vessel(figure10).

Thorax CT angiography was performed on the same day for another reason(dyspnea). CT angiography revealed a pseudoaneursym with a nodular density of 6mm diameter at biopsy localization in the left breast(Figure9).

Partial mastectomy was done to the patient whose core biopsy result was malign. In the same operation, the pseudoaneurysm area was surgically removed. Pathological result of partial mastectomy was carcinoma with signet-ring cell differantiation and high-grade ductal carcinoma in situ.