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12 Cards in this Set

  • Front
  • Back
Silicone injection

Innumerable high density rim-calcified masses are seen, characteristic of silicone granulomas 

Breast implant
Retropectoral, single lumen implant containing high density silicone
Single lumen, subglandular implants

Capsular c
Silicone injection

Innumerable high density rim-calcified masses are seen, characteristic of silicone granulomas

Breast implant
Retropectoral, single lumen implant containing high density silicone
Single lumen, subglandular implants

Capsular contracture in left breast implant  lost normal tear-drop shape

Saline breast implant
Gynecomastia

Proliferation of fibroglandular tissues resulting in breast enlargement
Hyperplasia of the ductal elements, fibroepithelium, and stroma (lobules do NOT develop)
Dense tissues fan out from retroareolar region rather than forming a mass

Bimodal age distribution: MC puberty, 5th decade
Etiology: excessive estrogens or deficient androgens
Idiopathic
Physiologic: newborn, puberty, senescence

Pathologic: Klinefelter's syndrome, congenital adrenal hyperplasia, adrenal neoplasms, testicular tumors, paraneoplastic syndromes, liver failure, thyrotoxicosis, testicular failure

Drugs: cannabinoids, psychotropics, antihypertensives (reserpine, spironolactone), digitalis, cimetedine, hormonal (estrogens, HCG, antiandrogens)

No increased risk for male breast cancer
Male breast cancer presents at a later stage so worse prognosis at presentation
Radial scar

Case findings:
7 mm density in retroareolar location in the left breast, with radiating linear strands surrounding it
Best seen on the CC view

Spiculated lesion, central nidus with internal radiolucencies (white star)

Predominantly radiolucent spiculations (rather than radiodense)
Requires open surgical biopsy  malignancy present in 25% of cases (some are invasive carcinomas, but others are radial scars that have small internal or adjacent areas of carcinoma)
Open surgical biopsy: less subject to sampling error than are percutaneous biopsy procedures (aspiration or core biopsy)

Spiculated lesion

Malignant:
MC invasive ductal (90%), invasive lobular (10%)
Malignant spicules: extend in all directions from a central tumor mass

Benign:
MC radial scar, sclerosing adenosis
Post-surgical scar: change in shape and density on different projections, contain central lucency, and regress over time, follow-up within 6 months
Benign spicules: bundled in parallel
Hamartoma (lipofibroadenoma, fibroadenolipoma)

Uncommon benign breast tumor
Composed of lipid, glandular, and fibrous tissues
May appear encapsulated, but does not possess a true capsule
Surrounded by a thin layer of fibrous tissue

Cut sausage and breast within a breast: terms used to describe the classic mammographic appearance of a breast hamartoma
Sebaceous cyst (epidermal inclusion cyst)

Round, smoothly bordered mass that often abuts the skin surface

Mass projects into the subcutaneous tissues rather than out from the skin surface

Tangential view of the mass demonstrates that it is located within the skin
Neurofibromatosis
Lipoma

Case findings:
very thin radiopaque border surrounding the mass is its fibrous capsule
BI-RADS 2: mass is fatty in density, and therefore benign

Fat containing mass, circumscribed radiolucent mass, with a thin capsule
Encapsulated mature adipose tissue
Soft lesion: can grow to substantial size before they become palpable
Can calcify, either within the capsule, or within the mass itself if there is central infarction
MC seen in postmenopausal women
Filariasis

Case findings:
Mammograms showed unusual serpiginous, tubular-wormlike calcifications without an accompanying mass
Serpiginous calcifications represent calcified degenerating parasite tissue (filarial granulomas of the breast)

Parasite: Wuchereria bancrofti, Brugia malayi
Ultrasound of right breast
Ultrasound of right breast
Phylloides tumor (cystosarcoma phyllodes)

Case findings:
US: multiple solids, hyperechoic nodules with central cystic components
CT: well-circumscribed tumor without obvious enhancement

Age: 45 years-old
Features:
Circumscribed round, oval or l
Phylloides tumor (cystosarcoma phyllodes)

Case findings:
US: multiple solids, hyperechoic nodules with central cystic components
CT: well-circumscribed tumor without obvious enhancement

Age: 45 years-old
Features:
Circumscribed round, oval or lobulated tumor, sometimes with partly indistinct borders
No spiculation on mammography
US: circumscribed hypoechoic lesions with varying degrees of inhomogeneity and small cystic spaces

Differentiation between benign and malignant phyllodes tumors is not possible on imaging
Locally invasive tumor which rarely metastasizes

DDX rapidly enlarging masses:
Phylloides tumor
Juvenile giant fibroadenoma
Abscess
Hematoma

Predominantly circumscribed malignant phyllodes tumor
Benign microcalcification
Plasma cell mastitis (secretory calcifications)
Fat necrosis
Fibroadenoma
Vascular
Benign calcifications
Benign microcalcification
Plasma cell mastitis (secretory calcifications)
Fat necrosis
Fibroadenoma
Vascular
Benign calcifications
Benign calcification

(a) Punctate: small grains of calcium, round, regular, dense, fairly equal in size, benign microcalcification

(b) Linear: long, dense, smooth, calcifications, outlining the ductal system, usually the result of ductal inflammatory changes

(c) Spherical: round or oval, having lucent centers, may be the result of fat necrosis as exemplified here, but may also represent small calcified cysts

(d) Coarse (popcorn): large, irregular, very high density, pathognomonic for calcified fibroadenoma

(e) Cylindrical: calcium deposits within walls of tubular structures might be vascular as illustrated here or past periductal inflammatory changes

(f) Smooth: dense, round, smoothly bordered, medium sized, isolated, benign grains of calcium
Calcification

(a) Jagged: coarse, dense, large, branching calcium deposits following inflammation or irradiation therapy (dermatomyositis this case)

(b) Heterogeneous: very small < 0.5 mm variable sizes, shapes and densities, highly suspicious (DCIS
Calcification

(a) Jagged: coarse, dense, large, branching calcium deposits following inflammation or irradiation therapy (dermatomyositis this case)

(b) Heterogeneous: very small < 0.5 mm variable sizes, shapes and densities, highly suspicious (DCIS this case)

(c) Regular: small, dense, round, benign microcalcification located at the periphery of a small calcifying cyst

(d) Branching: heterogeneous microcalcification, filling the ductal system with its dichotomic distribution, highly suspicious (high grade DCIS, comedo type this case)

Skin calcifications, polihedric, annular and dense
Tangential view: show that the calcifications are located in the skin

Rod shaped calcifications: stick-like, solid or hollow concretions, sometimes branching, usually the result of previous ductal inflammatory changes
Secretory calcification, or plasma cell mastitis

Acinar calcifications are concretions formed within acini of dilated lobules. Calcifications depicted here revealed a foci of lobular hyperplasia

Rim calcifications (eggshell): spherical capsules of fibroadenoma or as depicted here, calcified cystic capsules

Milk of calcium: precipitated amorphous calcium particles, floating within a cyst as seen on the left picture
True lateral position: particles may show the “tea cup” phenomenon as illustrated on the right

Suture calcification: knot-like, calcium deposits on suture materials seen in a postoperative, post-irradiated breast

Heterogeneous calcification: variable shape, variable size and variable density, may might show a branching pattern and are usually arranged in clusters or distributed according to the segmental partition of the breast (comedocarcinoma these 2 cases)
Rheumatoid arthritis

Case findings:
Enlarged dense axillary lymph nodes

DDX of enlarged axillary lymph nodes:
BCA with lymph node metastasis
Lymphoma
HIV
RA
TB, sarcoidosis
Benign reactive nodal hyperplasia

Metallic deposits in axillary no
Rheumatoid arthritis

Case findings:
Enlarged dense axillary lymph nodes

DDX of enlarged axillary lymph nodes:
BCA with lymph node metastasis
Lymphoma
HIV
RA
TB, sarcoidosis
Benign reactive nodal hyperplasia

Metallic deposits in axillary nodes from RA gold injections

DDX of calcified axillary lymph nodes:
MC metastasis (ovarian, mucinous tumors)
RA with gold treatment
Treated lymphoma

Metallic deposits in axillary nodes from RA gold injections