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Unusual Breast Lesions: Radiologic-Pathologic Correlation¹

¹ From the Departments of Radiology (J.M.F., E.S.D., J.P.H.) and Pathology (J.J.W.), Medical College of Virginia, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23298. Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received March 29, 1999; revision requested April 20 and received May 17; accepted May 17. Address reprint requests to E.S.D.

View larger version (69K): [in a new window]   Figure 1.   Rheumatoid arthritis. Left mediolateral oblique mammogram demonstrates enlarged, dense axillary lymph nodes (arrows).

View larger version (103K): [in a new window]   Figure 2a.   Sarcoidosis in a 38-year-old woman who presented to the emergency department with abdominal pain. Abdominal ultrasonography (US) and computed tomography showed diffuse intraabdominal lymphadenopathy. (a) Right mediolateral oblique mammogram reveals enlarged axillary lymph nodes (arrow). (b) Axillary US image shows a lymph node (arrow) as a hypoechoic, circumscribed mass with a hyperechoic center that represents the fatty hilum of the node. Findings at bilateral axillary US confirmed lymphadenopathy. (c) Photomicrograph (original magnification, x400; Diff-Quik stain) of aspirate obtained at US-guided fine-needle biopsy demonstrates collections of epithelioid histiocytes with abundant cytoplasm and footprint-shaped nuclei (arrow) that together form noncaseating granulomas. This finding is consistent with sarcoidosis. Follow-up chest radiography demonstrated stage III sarcoidosis changes.

View larger version (150K): [in a new window]   Figure 2b.   Sarcoidosis in a 38-year-old woman who presented to the emergency department with abdominal pain. Abdominal ultrasonography (US) and computed tomography showed diffuse intraabdominal lymphadenopathy. (a) Right mediolateral oblique mammogram reveals enlarged axillary lymph nodes (arrow). (b) Axillary US image shows a lymph node (arrow) as a hypoechoic, circumscribed mass with a hyperechoic center that represents the fatty hilum of the node. Findings at bilateral axillary US confirmed lymphadenopathy. (c) Photomicrograph (original magnification, x400; Diff-Quik stain) of aspirate obtained at US-guided fine-needle biopsy demonstrates collections of epithelioid histiocytes with abundant cytoplasm and footprint-shaped nuclei (arrow) that together form noncaseating granulomas. This finding is consistent with sarcoidosis. Follow-up chest radiography demonstrated stage III sarcoidosis changes.

View larger version (159K): [in a new window]   Figure 2c.   Sarcoidosis in a 38-year-old woman who presented to the emergency department with abdominal pain. Abdominal ultrasonography (US) and computed tomography showed diffuse intraabdominal lymphadenopathy. (a) Right mediolateral oblique mammogram reveals enlarged axillary lymph nodes (arrow). (b) Axillary US image shows a lymph node (arrow) as a hypoechoic, circumscribed mass with a hyperechoic center that represents the fatty hilum of the node. Findings at bilateral axillary US confirmed lymphadenopathy. (c) Photomicrograph (original magnification, x400; Diff-Quik stain) of aspirate obtained at US-guided fine-needle biopsy demonstrates collections of epithelioid histiocytes with abundant cytoplasm and footprint-shaped nuclei (arrow) that together form noncaseating granulomas. This finding is consistent with sarcoidosis. Follow-up chest radiography demonstrated stage III sarcoidosis changes.

View larger version (149K): [in a new window]   Figure 3.   Rheumatoid arthritis in a postmenopausal woman who received gold salt injections. Right mediolateral oblique screening mammogram shows metallic deposits in the axillary lymph nodes (arrows).

View larger version (116K): [in a new window]   Figure 4.   Dermatomyositis in a 38-year-old woman with a history of scleroderma and dermatomyositis. Left mediolateral oblique mammogram demonstrates bizarre, confluent dystrophic subcutaneous calcifications that obscure most of the breast parenchyma (arrow). No palpable mass was found at clinical examination. BB indicates the location of a mole on the skin.

View larger version (116K): [in a new window]   Figure 5.   Wegener granulomatosis in a postmenopausal woman with a palpable breast mass. Mammogram shows an irregularly shaped, high-density mass (arrow) simulating breast cancer. Wegener granulomatosis was confirmed at subsequent excisional biopsy.

View larger version (101K): [in a new window]   Figure 6a.   Diabetic fibrous mastopathy in a 35-year-old woman with long-standing type 1 diabetes mellitus who presented with a palpable mass in the right breast. (a) Bilateral craniocaudal mammogram shows mirror-image focal areas of dense parenchyma in both breasts (arrowheads). BB indicates the palpable mass in the right breast; the lesion in the left breast was nonpalpable. (b) US image of the palpable mass demonstrates an irregular, hypoechoic mass with very dense posterior acoustic shadowing (arrows). (c) Photomicrograph (original magnification, x40; hematoxylin-eosin [H-E] stain) shows dense stromal fibrosis obliterating breast lobules and ducts (arrows).

View larger version (134K): [in a new window]   Figure 6b.   Diabetic fibrous mastopathy in a 35-year-old woman with long-standing type 1 diabetes mellitus who presented with a palpable mass in the right breast. (a) Bilateral craniocaudal mammogram shows mirror-image focal areas of dense parenchyma in both breasts (arrowheads). BB indicates the palpable mass in the right breast; the lesion in the left breast was nonpalpable. (b) US image of the palpable mass demonstrates an irregular, hypoechoic mass with very dense posterior acoustic shadowing (arrows). (c) Photomicrograph (original magnification, x40; hematoxylin-eosin [H-E] stain) shows dense stromal fibrosis obliterating breast lobules and ducts (arrows).

View larger version (194K): [in a new window]   Figure 6c.   Diabetic fibrous mastopathy in a 35-year-old woman with long-standing type 1 diabetes mellitus who presented with a palpable mass in the right breast. (a) Bilateral craniocaudal mammogram shows mirror-image focal areas of dense parenchyma in both breasts (arrowheads). BB indicates the palpable mass in the right breast; the lesion in the left breast was nonpalpable. (b) US image of the palpable mass demonstrates an irregular, hypoechoic mass with very dense posterior acoustic shadowing (arrows). (c) Photomicrograph (original magnification, x40; hematoxylin-eosin [H-E] stain) shows dense stromal fibrosis obliterating breast lobules and ducts (arrows).

View larger version (129K): [in a new window]   Figure 7a.   Secondary hyperparathyroidism due to chronic renal failure in a 57-year-old woman with end-stage renal disease secondary to hypertension. The patient was undergoing hemodialysis after having undergone peritoneal dialysis for the past 6 years. (a) Craniocaudal mammogram of the left breast demonstrates early vascular calcification. (b) Craniocaudal mammogram of the left breast obtained 1 year later demonstrates dramatic progressive development of diffuse coarse soft-tissue (large arrows) and vascular (small arrows) calcifications. These findings are characteristic of secondary hyperparathyroidism.

View larger version (125K): [in a new window]   Figure 7b.   Secondary hyperparathyroidism due to chronic renal failure in a 57-year-old woman with end-stage renal disease secondary to hypertension. The patient was undergoing hemodialysis after having undergone peritoneal dialysis for the past 6 years. (a) Craniocaudal mammogram of the left breast demonstrates early vascular calcification. (b) Craniocaudal mammogram of the left breast obtained 1 year later demonstrates dramatic progressive development of diffuse coarse soft-tissue (large arrows) and vascular (small arrows) calcifications. These findings are characteristic of secondary hyperparathyroidism.

View larger version (58K): [in a new window]   Figure 8a.   Steatocystoma multiplex in a 63-year-old woman with palpable subcutaneous nodules in the cleavage area of the breasts and in the arms. (a) Mammogram of the cleavage area shows multiple oil cysts with peripheral calcifications in the subcutaneous areas of both breasts (arrows). (b) Mammogram (magnification view) demonstrates an oil cyst (arrow) in the subcutaneous area of the right breast. (c) Radiograph of the forearm obtained with soft-tissue technique shows a similar oil cyst (arrow).

View larger version (96K): [in a new window]   Figure 8b.   Steatocystoma multiplex in a 63-year-old woman with palpable subcutaneous nodules in the cleavage area of the breasts and in the arms. (a) Mammogram of the cleavage area shows multiple oil cysts with peripheral calcifications in the subcutaneous areas of both breasts (arrows). (b) Mammogram (magnification view) demonstrates an oil cyst (arrow) in the subcutaneous area of the right breast. (c) Radiograph of the forearm obtained with soft-tissue technique shows a similar oil cyst (arrow).

View larger version (42K): [in a new window]   Figure 8c.   Steatocystoma multiplex in a 63-year-old woman with palpable subcutaneous nodules in the cleavage area of the breasts and in the arms. (a) Mammogram of the cleavage area shows multiple oil cysts with peripheral calcifications in the subcutaneous areas of both breasts (arrows). (b) Mammogram (magnification view) demonstrates an oil cyst (arrow) in the subcutaneous area of the right breast. (c) Radiograph of the forearm obtained with soft-tissue technique shows a similar oil cyst (arrow).

View larger version (120K): [in a new window]   Figure 9a.   Fibromatosis in a 26-year-old woman who presented with a palpable mass in the right breast with concomitant nipple retraction. (a) Right mediolateral oblique mammogram demonstrates a spiculated high-density mass overlying the pectoral muscle in the posterior aspect of the breast simulating cancer (arrow). BB indicates mole. Subsequent excisional biopsy with wide margins revealed an extraabdominal desmoid tumor (fibromatosis). (b) Photomicrograph (original magnification, x100; H-E stain) shows fascicles of bland fibroblasts (arrows) entrapping benign breast lobules (arrowheads) and fat.

View larger version (200K): [in a new window]   Figure 9b.   Fibromatosis in a 26-year-old woman who presented with a palpable mass in the right breast with concomitant nipple retraction. (a) Right mediolateral oblique mammogram demonstrates a spiculated high-density mass overlying the pectoral muscle in the posterior aspect of the breast simulating cancer (arrow). BB indicates mole. Subsequent excisional biopsy with wide margins revealed an extraabdominal desmoid tumor (fibromatosis). (b) Photomicrograph (original magnification, x100; H-E stain) shows fascicles of bland fibroblasts (arrows) entrapping benign breast lobules (arrowheads) and fat.

View larger version (127K): [in a new window]   Figure 10a.   Granular cell tumor in a 47-year-old asymptomatic woman who presented for routine screening mammography. (a) Right mediolateral oblique mammogram shows a high-density mass with indistinct margins in the posterior aspect of the breast (arrow). Subsequent excisional biopsy with preoperative needle localization revealed the mass to be a granular cell tumor. (b) Specimen radiograph obtained following excisional biopsy shows an irregularly shaped, high-density spiculated mass with indistinct margins closely resembling cancer.

View larger version (111K): [in a new window]   Figure 10b.   Granular cell tumor in a 47-year-old asymptomatic woman who presented for routine screening mammography. (a) Right mediolateral oblique mammogram shows a high-density mass with indistinct margins in the posterior aspect of the breast (arrow). Subsequent excisional biopsy with preoperative needle localization revealed the mass to be a granular cell tumor. (b) Specimen radiograph obtained following excisional biopsy shows an irregularly shaped, high-density spiculated mass with indistinct margins closely resembling cancer.

View larger version (161K): [in a new window]   Figures 11, 12.   (11) Granular cell tumor in a 46-year-old woman who presented with a palpable mass that had first been noticed 6 weeks earlier. US image demonstrates a lobulated, hypoechoic solid mass (arrow). Subsequent excisional biopsy revealed a granular cell tumor. (12) Granular cell tumor. Photomicrograph (original magnification, x200; H-E stain) demonstrates nests of polyhedral cells with abundant eosinophilic granular cytoplasm and bland, centrally located nuclei.

View larger version (194K): [in a new window]   Figures 11, 12.   (11) Granular cell tumor in a 46-year-old woman who presented with a palpable mass that had first been noticed 6 weeks earlier. US image demonstrates a lobulated, hypoechoic solid mass (arrow). Subsequent excisional biopsy revealed a granular cell tumor. (12) Granular cell tumor. Photomicrograph (original magnification, x200; H-E stain) demonstrates nests of polyhedral cells with abundant eosinophilic granular cytoplasm and bland, centrally located nuclei.

View larger version (103K): [in a new window]   Figures 13, 14.   Hamartoma. (13) On a left craniocaudal mammogram, hamartoma has a classic benign appearance as a well-circumscribed, fat-containing mass with mixed density and a thin, radiopaque pseudocapsule (arrows). (14) Photomicrograph (original magnification, x100; H-E stain) shows a well-encapsulated lesion composed of varying amounts of normal benign breast elements. Increased numbers of benign lobules with fibrocystic changes, cystically dilated glands, and apocrine metaplasia are also seen (arrowheads).

View larger version (193K): [in a new window]   Figures 13, 14.   Hamartoma. (13) On a left craniocaudal mammogram, hamartoma has a classic benign appearance as a well-circumscribed, fat-containing mass with mixed density and a thin, radiopaque pseudocapsule (arrows). (14) Photomicrograph (original magnification, x100; H-E stain) shows a well-encapsulated lesion composed of varying amounts of normal benign breast elements. Increased numbers of benign lobules with fibrocystic changes, cystically dilated glands, and apocrine metaplasia are also seen (arrowheads).

View larger version (85K): [in a new window]   Figures 15, 16.   (15) Phyllodes tumor in a 46-year-old woman with a newly developed, rapidly enlarging mass. Right mediolateral mammogram shows a large, oval, well-defined isodense mass (large arrow) with a radiolucent halo (small arrows). A high-grade phyllodes tumor with extension to the pectoral muscle was seen at excisional biopsy. At pathologic analysis, the margins of the surgical specimen were positive for tumor. (16) Phyllodes tumor. US image shows an inhomogeneous solid mass with cystic spaces and posterior acoustic enhancement (arrows).

View larger version (149K): [in a new window]   Figures 15, 16.   (15) Phyllodes tumor in a 46-year-old woman with a newly developed, rapidly enlarging mass. Right mediolateral mammogram shows a large, oval, well-defined isodense mass (large arrow) with a radiolucent halo (small arrows). A high-grade phyllodes tumor with extension to the pectoral muscle was seen at excisional biopsy. At pathologic analysis, the margins of the surgical specimen were positive for tumor. (16) Phyllodes tumor. US image shows an inhomogeneous solid mass with cystic spaces and posterior acoustic enhancement (arrows).

View larger version (191K): [in a new window]   Figure 17.   Benign phyllodes tumor. Photomicrograph (original magnification, x100; H-E stain) shows a well-encapsulated tumor composed of leaflike processes lined by bland epithelium (arrows). The somewhat hypercellular stroma demonstrates no atypia and low mitotic activity.

View larger version (212K): [in a new window]   Figure 18a.   Malignant phyllodes tumor. (a) Photomicrograph (original magnification, x100; H-E stain) demonstrates more cellular stroma with condensation of the stroma around the glands (arrows) compared with the benign phyllodes tumor (cf Fig 17). The amorphous pink areas in the clefts represent proteinaceous material that has taken up the eosinophilic stain. (b) Higher-power photomicrograph (original magnification, x400; H-E stain) demonstrates significant nuclear atypia and increased mitoses (arrows) compared with the benign phyllodes tumor.

View larger version (203K): [in a new window]   Figure 18b.   Malignant phyllodes tumor. (a) Photomicrograph (original magnification, x100; H-E stain) demonstrates more cellular stroma with condensation of the stroma around the glands (arrows) compared with the benign phyllodes tumor (cf Fig 17). The amorphous pink areas in the clefts represent proteinaceous material that has taken up the eosinophilic stain. (b) Higher-power photomicrograph (original magnification, x400; H-E stain) demonstrates significant nuclear atypia and increased mitoses (arrows) compared with the benign phyllodes tumor.

View larger version (72K): [in a new window]   Figure 19.   Recurrent phyllodes tumor in the same patient as in Figure 15. Right mediolateral oblique mammogram obtained 1 year after inadequate wide excision of the tumor shows a large, multilobulated mass (arrows).

View larger version (94K): [in a new window]   Figure 20a.   Primary lymphoma in a 40-year-old woman who presented for routine screening mammography. (a) Left mediolateral oblique mammogram shows a partially well-circumscribed, oval, palpable, high-density mass (arrow). Several small tumor nodules are seen posteriorly (arrowheads). Excisional biopsy revealed a primary large cell non-Hodgkin lymphoma. The patient underwent radiation therapy and chemotherapy and experienced interval resolution of the small posterior nodules. (b) Photomicrograph (original magnification, x400; H-E stain) demonstrates large cell non-Hodgkin lymphoma of the breast. The lesion is characterized by sheets of cells with large, convoluted nuclei containing prominent nucleoli and scant cytoplasm. (c) Follow-up mammogram obtained 3 years later shows a new bilobed mass posteriorly (arrow). BB indicates mole. A new, small cleaved cell-type non-Hodgkin lymphoma was identified at excisional biopsy. (d) Photomicrograph (original magnification, x400; H-E stain) shows nodular aggregates of small cleaved lymphocytes. Results of immunologic studies were consistent with small cleaved cell-type non-Hodgkin lymphoma.

View larger version (204K): [in a new window]   Figure 20b.   Primary lymphoma in a 40-year-old woman who presented for routine screening mammography. (a) Left mediolateral oblique mammogram shows a partially well-circumscribed, oval, palpable, high-density mass (arrow). Several small tumor nodules are seen posteriorly (arrowheads). Excisional biopsy revealed a primary large cell non-Hodgkin lymphoma. The patient underwent radiation therapy and chemotherapy and experienced interval resolution of the small posterior nodules. (b) Photomicrograph (original magnification, x400; H-E stain) demonstrates large cell non-Hodgkin lymphoma of the breast. The lesion is characterized by sheets of cells with large, convoluted nuclei containing prominent nucleoli and scant cytoplasm. (c) Follow-up mammogram obtained 3 years later shows a new bilobed mass posteriorly (arrow). BB indicates mole. A new, small cleaved cell-type non-Hodgkin lymphoma was identified at excisional biopsy. (d) Photomicrograph (original magnification, x400; H-E stain) shows nodular aggregates of small cleaved lymphocytes. Results of immunologic studies were consistent with small cleaved cell-type non-Hodgkin lymphoma.

View larger version (100K): [in a new window]   Figure 20c.   Primary lymphoma in a 40-year-old woman who presented for routine screening mammography. (a) Left mediolateral oblique mammogram shows a partially well-circumscribed, oval, palpable, high-density mass (arrow). Several small tumor nodules are seen posteriorly (arrowheads). Excisional biopsy revealed a primary large cell non-Hodgkin lymphoma. The patient underwent radiation therapy and chemotherapy and experienced interval resolution of the small posterior nodules. (b) Photomicrograph (original magnification, x400; H-E stain) demonstrates large cell non-Hodgkin lymphoma of the breast. The lesion is characterized by sheets of cells with large, convoluted nuclei containing prominent nucleoli and scant cytoplasm. (c) Follow-up mammogram obtained 3 years later shows a new bilobed mass posteriorly (arrow). BB indicates mole. A new, small cleaved cell-type non-Hodgkin lymphoma was identified at excisional biopsy. (d) Photomicrograph (original magnification, x400; H-E stain) shows nodular aggregates of small cleaved lymphocytes. Results of immunologic studies were consistent with small cleaved cell-type non-Hodgkin lymphoma.

View larger version (194K): [in a new window]   Figure 20d.   Primary lymphoma in a 40-year-old woman who presented for routine screening mammography. (a) Left mediolateral oblique mammogram shows a partially well-circumscribed, oval, palpable, high-density mass (arrow). Several small tumor nodules are seen posteriorly (arrowheads). Excisional biopsy revealed a primary large cell non-Hodgkin lymphoma. The patient underwent radiation therapy and chemotherapy and experienced interval resolution of the small posterior nodules. (b) Photomicrograph (original magnification, x400; H-E stain) demonstrates large cell non-Hodgkin lymphoma of the breast. The lesion is characterized by sheets of cells with large, convoluted nuclei containing prominent nucleoli and scant cytoplasm. (c) Follow-up mammogram obtained 3 years later shows a new bilobed mass posteriorly (arrow). BB indicates mole. A new, small cleaved cell-type non-Hodgkin lymphoma was identified at excisional biopsy. (d) Photomicrograph (original magnification, x400; H-E stain) shows nodular aggregates of small cleaved lymphocytes. Results of immunologic studies were consistent with small cleaved cell-type non-Hodgkin lymphoma.

View larger version (132K): [in a new window]   Figures 21, 22.   (21) Carcino-osteosarcoma in a postmenopausal woman who presented with a palpable mass in the right breast. Spot magnification mammogram shows amorphous mineralization of osteoid matrix (arrow). Excisional biopsy revealed a carcino-osteosarcoma. (22) Carcinosarcoma in a 65-year-old asymptomatic woman. (a) Left mediolateral oblique screening mammogram reveals an ill-defined mass with calcifications (arrow). Pathologic analysis of a specimen obtained with stereotactic core needle biopsy demonstrated a carcinosarcoma. (b) Photomicrograph (original magnification, x100; H-E stain) shows the tumor to be characterized by malignant epithelial elements (ductal carcinoma in situ with comedonecrosis [arrows], intermixed with malignant stroma—in this case, osteosarcoma [arrowheads] and undifferentiated sarcoma [bottom]).

View larger version (71K): [in a new window]   Figures 21, 22.   (21) Carcino-osteosarcoma in a postmenopausal woman who presented with a palpable mass in the right breast. Spot magnification mammogram shows amorphous mineralization of osteoid matrix (arrow). Excisional biopsy revealed a carcino-osteosarcoma. (22) Carcinosarcoma in a 65-year-old asymptomatic woman. (a) Left mediolateral oblique screening mammogram reveals an ill-defined mass with calcifications (arrow). Pathologic analysis of a specimen obtained with stereotactic core needle biopsy demonstrated a carcinosarcoma. (b) Photomicrograph (original magnification, x100; H-E stain) shows the tumor to be characterized by malignant epithelial elements (ductal carcinoma in situ with comedonecrosis [arrows], intermixed with malignant stroma—in this case, osteosarcoma [arrowheads] and undifferentiated sarcoma [bottom]).

View larger version (206K): [in a new window]   Figures 21, 22.   (21) Carcino-osteosarcoma in a postmenopausal woman who presented with a palpable mass in the right breast. Spot magnification mammogram shows amorphous mineralization of osteoid matrix (arrow). Excisional biopsy revealed a carcino-osteosarcoma. (22) Carcinosarcoma in a 65-year-old asymptomatic woman. (a) Left mediolateral oblique screening mammogram reveals an ill-defined mass with calcifications (arrow). Pathologic analysis of a specimen obtained with stereotactic core needle biopsy demonstrated a carcinosarcoma. (b) Photomicrograph (original magnification, x100; H-E stain) shows the tumor to be characterized by malignant epithelial elements (ductal carcinoma in situ with comedonecrosis [arrows], intermixed with malignant stroma—in this case, osteosarcoma [arrowheads] and undifferentiated sarcoma [bottom]).

View larger version (109K): [in a new window]   Figure 23a.   Adenoid cystic carcinoma. (a) Left craniocaudal mammogram demonstrates a lobulated, isodense mass with relatively well-defined margins in the lateral portion of the breast (arrow) corresponding to a palpable, mobile nodule that was found at clinical examination. Adenoid cystic carcinoma was diagnosed at excisional biopsy. (b) Photomicrograph (original magnification, x100; H-E stain) shows tubular and cribriform collections of basaloid cells infiltrating the breast tissue. The cystic spaces in the cribriform areas contain either hyaline basement membrane-like material (straight arrow) or pale, basophilic mucoid material (curved arrow).

View larger version (211K): [in a new window]   Figure 23b.   Adenoid cystic carcinoma. (a) Left craniocaudal mammogram demonstrates a lobulated, isodense mass with relatively well-defined margins in the lateral portion of the breast (arrow) corresponding to a palpable, mobile nodule that was found at clinical examination. Adenoid cystic carcinoma was diagnosed at excisional biopsy. (b) Photomicrograph (original magnification, x100; H-E stain) shows tubular and cribriform collections of basaloid cells infiltrating the breast tissue. The cystic spaces in the cribriform areas contain either hyaline basement membrane-like material (straight arrow) or pale, basophilic mucoid material (curved arrow).

View larger version (55K): [in a new window]   Figures 24-26.   (24) Metastatic fallopian tube carcinoma in a 45-year-old woman who presented with peau d'orange skin changes in the left breast. Left mediolateral oblique mammogram shows diffuse skin thickening (arrowheads). Incisional biopsy revealed metastatic fallopian tube carcinoma. (25) Metastatic lymphoma in an 85-year-old woman with known lymphoma who presented for routine screening mammography. Left mediolateral oblique mammogram shows an irregularly shaped, isodense mass (arrow). Metastatic lymphoma was found at excisional biopsy. (26) Metastatic papillary carcinoma from an unknown primary site in a 65-year-old woman. Right mediolateral oblique mammogram demonstrates a large, high-density mass in the axilla. Peripheral psammomatous calcifications are also present (arrows). Biopsy revealed nonmammary papillary cancer with no identifiable primary site.

View larger version (69K): [in a new window]   Figures 24-26.   (24) Metastatic fallopian tube carcinoma in a 45-year-old woman who presented with peau d'orange skin changes in the left breast. Left mediolateral oblique mammogram shows diffuse skin thickening (arrowheads). Incisional biopsy revealed metastatic fallopian tube carcinoma. (25) Metastatic lymphoma in an 85-year-old woman with known lymphoma who presented for routine screening mammography. Left mediolateral oblique mammogram shows an irregularly shaped, isodense mass (arrow). Metastatic lymphoma was found at excisional biopsy. (26) Metastatic papillary carcinoma from an unknown primary site in a 65-year-old woman. Right mediolateral oblique mammogram demonstrates a large, high-density mass in the axilla. Peripheral psammomatous calcifications are also present (arrows). Biopsy revealed nonmammary papillary cancer with no identifiable primary site.

View larger version (79K): [in a new window]   Figures 24-26.   (24) Metastatic fallopian tube carcinoma in a 45-year-old woman who presented with peau d'orange skin changes in the left breast. Left mediolateral oblique mammogram shows diffuse skin thickening (arrowheads). Incisional biopsy revealed metastatic fallopian tube carcinoma. (25) Metastatic lymphoma in an 85-year-old woman with known lymphoma who presented for routine screening mammography. Left mediolateral oblique mammogram shows an irregularly shaped, isodense mass (arrow). Metastatic lymphoma was found at excisional biopsy. (26) Metastatic papillary carcinoma from an unknown primary site in a 65-year-old woman. Right mediolateral oblique mammogram demonstrates a large, high-density mass in the axilla. Peripheral psammomatous calcifications are also present (arrows). Biopsy revealed nonmammary papillary cancer with no identifiable primary site.