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Fibrous Lesions of the Breast: Imaging-Pathologic Correlation¹

¹ From the Ellen Shaw de Paredes Institute for Women’s Imaging, 4480 Cox Rd, Suite 100, Glen Allen, VA 23060. Presented as an education exhibit at the 2002 RSNA Annual Meeting. Received September 27, 2004; revision requested December 7 and received January 18, 2005; accepted January 19. Supported by a grant from the Blanton-Sweeney Research Endowment. All authors have no financial relationships to disclose.

View larger version (140K): [in a new window]   Figure 1a.  (a) Photograph of gross specimen shows a well-circumscribed solid lesion with numerous lobulations. (b, c) Left craniocaudal (b) and mediolateral oblique (c) mammographic views show an extremely dense breast with a normal parenchyma that is nearly eclipsed by a large high-density mass. (d) Medium-power photomicrograph (hematoxylin-eosin stain) shows a giant fibroadenoma with an intracanalicular (compressed) glandular growth pattern.

 

View larger version (90K): [in a new window]   Figure 1b.  (a) Photograph of gross specimen shows a well-circumscribed solid lesion with numerous lobulations. (b, c) Left craniocaudal (b) and mediolateral oblique (c) mammographic views show an extremely dense breast with a normal parenchyma that is nearly eclipsed by a large high-density mass. (d) Medium-power photomicrograph (hematoxylin-eosin stain) shows a giant fibroadenoma with an intracanalicular (compressed) glandular growth pattern.

 

View larger version (92K): [in a new window]   Figure 1c.  (a) Photograph of gross specimen shows a well-circumscribed solid lesion with numerous lobulations. (b, c) Left craniocaudal (b) and mediolateral oblique (c) mammographic views show an extremely dense breast with a normal parenchyma that is nearly eclipsed by a large high-density mass. (d) Medium-power photomicrograph (hematoxylin-eosin stain) shows a giant fibroadenoma with an intracanalicular (compressed) glandular growth pattern.

 

View larger version (177K): [in a new window]   Figure 1d.  (a) Photograph of gross specimen shows a well-circumscribed solid lesion with numerous lobulations. (b, c) Left craniocaudal (b) and mediolateral oblique (c) mammographic views show an extremely dense breast with a normal parenchyma that is nearly eclipsed by a large high-density mass. (d) Medium-power photomicrograph (hematoxylin-eosin stain) shows a giant fibroadenoma with an intracanalicular (compressed) glandular growth pattern.

 

View larger version (96K): [in a new window]   Figure 2a.  Fibroadenoma in a 35-year-old woman. Left craniocaudal (a) and spot magnification (b) views show a high-density circumscribed lobular mass with a medial location in the breast. On the basis of the results of pathologic analysis, the mass was diagnosed as fibroadenoma.

 

View larger version (126K): [in a new window]   Figure 2b.  Fibroadenoma in a 35-year-old woman. Left craniocaudal (a) and spot magnification (b) views show a high-density circumscribed lobular mass with a medial location in the breast. On the basis of the results of pathologic analysis, the mass was diagnosed as fibroadenoma.

 

View larger version (123K): [in a new window]   Figure 3.  Left mediolateral oblique magnification view shows a lobular circumscribed mass with coarse popcorn-shaped calcifications characteristic of fibroadenoma.

 

View larger version (135K): [in a new window]   Figure 4.  Right mediolateral oblique magnification view shows a circumscribed mass in the subareolar area with a single peripheral calcification. This pattern of calcification is typical of early degeneration in fibroadenoma.

 

View larger version (119K): [in a new window]   Figure 5a.  (a) Left spot magnification mammographic view shows a nonpalpable mass with features that are highly suggestive of fibroadenoma, including an elliptic shape and a well-defined margin. (b) US image shows an elliptic area of uniform hypoechogenicity. (c) Low-power photomicrograph (hematoxylin-eosin stain) of a core-needle biopsy specimen shows the abundant hyalinized stroma and intracanalicular pattern characteristic of fibroadenoma. (d) Medium-power photomicrograph of the specimen shows compressed canaliculi.

 

View larger version (158K): [in a new window]   Figure 5b.  (a) Left spot magnification mammographic view shows a nonpalpable mass with features that are highly suggestive of fibroadenoma, including an elliptic shape and a well-defined margin. (b) US image shows an elliptic area of uniform hypoechogenicity. (c) Low-power photomicrograph (hematoxylin-eosin stain) of a core-needle biopsy specimen shows the abundant hyalinized stroma and intracanalicular pattern characteristic of fibroadenoma. (d) Medium-power photomicrograph of the specimen shows compressed canaliculi.

 

View larger version (166K): [in a new window]   Figure 5c.  (a) Left spot magnification mammographic view shows a nonpalpable mass with features that are highly suggestive of fibroadenoma, including an elliptic shape and a well-defined margin. (b) US image shows an elliptic area of uniform hypoechogenicity. (c) Low-power photomicrograph (hematoxylin-eosin stain) of a core-needle biopsy specimen shows the abundant hyalinized stroma and intracanalicular pattern characteristic of fibroadenoma. (d) Medium-power photomicrograph of the specimen shows compressed canaliculi.

 

View larger version (179K): [in a new window]   Figure 5d.  (a) Left spot magnification mammographic view shows a nonpalpable mass with features that are highly suggestive of fibroadenoma, including an elliptic shape and a well-defined margin. (b) US image shows an elliptic area of uniform hypoechogenicity. (c) Low-power photomicrograph (hematoxylin-eosin stain) of a core-needle biopsy specimen shows the abundant hyalinized stroma and intracanalicular pattern characteristic of fibroadenoma. (d) Medium-power photomicrograph of the specimen shows compressed canaliculi.

 

View larger version (112K): [in a new window]   Figure 6a.  (a) Left mediolateral oblique spot mammographic view, obtained at routine screening in a 45-year-old woman with a history of benign breast biopsy, shows a somewhat obscured round mass with features that are most suggestive of a benign lesion. (b) Medium-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows clearly defined borders, loose fibrous stroma, and the open rounded ductules typical of fibroadenoma with a pericanalicular pattern of development.

 

View larger version (217K): [in a new window]   Figure 6b.  (a) Left mediolateral oblique spot mammographic view, obtained at routine screening in a 45-year-old woman with a history of benign breast biopsy, shows a somewhat obscured round mass with features that are most suggestive of a benign lesion. (b) Medium-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows clearly defined borders, loose fibrous stroma, and the open rounded ductules typical of fibroadenoma with a pericanalicular pattern of development.

 

View larger version (129K): [in a new window]   Figure 7a.  (a) Left craniocaudal view obtained at screening mammography in a 45-year-old woman shows a small lobular mass with slightly indistinct margins (arrow). (b) High-power photomicrograph (hematoxylin-eosin stain) shows a tubular adenoma, a well-circumscribed aggregate of compact proliferating tubules with very little intervening stroma, surrounded by a delicate and poorly formed capsule. The densely packed tubules in this type of adenoma are lined by epithelial and myoepithelial cell layers.

 

View larger version (185K): [in a new window]   Figure 7b.  (a) Left craniocaudal view obtained at screening mammography in a 45-year-old woman shows a small lobular mass with slightly indistinct margins (arrow). (b) High-power photomicrograph (hematoxylin-eosin stain) shows a tubular adenoma, a well-circumscribed aggregate of compact proliferating tubules with very little intervening stroma, surrounded by a delicate and poorly formed capsule. The densely packed tubules in this type of adenoma are lined by epithelial and myoepithelial cell layers.

 

View larger version (135K): [in a new window]   Figure 8.  US image of a palpable mass in the right breast of a 17-year-old female patient shows a large lobular circumscribed hypoechoic lesion that, on the basis of the lesion features and the age of the patient, is most likely a juvenile fibroadenoma.

 

View larger version (94K): [in a new window]   Figure 9a.  (a) Right mediolateral oblique view of a palpable breast lesion in a 49-year-old woman shows a lobulated mass with a central area of high density. (b) US image shows a large central solid area and small peripheral cystic spaces, findings suggestive of a phyllodes tumor. Results of pathologic analysis confirmed the presence of a benign phyllodes tumor.

 

View larger version (94K): [in a new window]   Figure 9b.  (a) Right mediolateral oblique view of a palpable breast lesion in a 49-year-old woman shows a lobulated mass with a central area of high density. (b) US image shows a large central solid area and small peripheral cystic spaces, findings suggestive of a phyllodes tumor. Results of pathologic analysis confirmed the presence of a benign phyllodes tumor.

 

View larger version (119K): [in a new window]   Figure 10.  Bilateral mediolateral oblique views show marked discrepancy in breast size in a 63-year-old woman, with the right breast filled by a very large round high-density mass that is likely, on the basis of its shape and size, to be a phyllodes tumor. Histopathologic findings after excision confirmed a diagnosis of benign phyllodes tumor.

 

View larger version (133K): [in a new window]   Figure 11a.  (a) Right craniocaudal view obtained at screening mammography in a 38-year-old patient shows a lobular isodense mass (white dot) near the center of the breast, a finding suggestive of a benign lesion. (b) US image shows a round lesion that is hypoechoic, a feature inconsistent with a benign lesion. (c) Low-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows features of a malignant phyllodes tumor, with classic stromal overgrowth, sparse epithelial components, infiltrative borders, and more than five mitoses per 10 high-power field.

 

View larger version (182K): [in a new window]   Figure 11b.  (a) Right craniocaudal view obtained at screening mammography in a 38-year-old patient shows a lobular isodense mass (white dot) near the center of the breast, a finding suggestive of a benign lesion. (b) US image shows a round lesion that is hypoechoic, a feature inconsistent with a benign lesion. (c) Low-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows features of a malignant phyllodes tumor, with classic stromal overgrowth, sparse epithelial components, infiltrative borders, and more than five mitoses per 10 high-power field.

 

View larger version (227K): [in a new window]   Figure 11c.  (a) Right craniocaudal view obtained at screening mammography in a 38-year-old patient shows a lobular isodense mass (white dot) near the center of the breast, a finding suggestive of a benign lesion. (b) US image shows a round lesion that is hypoechoic, a feature inconsistent with a benign lesion. (c) Low-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows features of a malignant phyllodes tumor, with classic stromal overgrowth, sparse epithelial components, infiltrative borders, and more than five mitoses per 10 high-power field.

 

View larger version (69K): [in a new window]   Figure 12a.  (a, b) Left mediolateral oblique magnification (a) and coned-down exaggerated craniocaudal-lateral magnification (b) views obtained at mammography in a 28-year-old patient show a very large oval-shaped high-density mass in a posterior location that extends to the pectoralis major muscle. (c) US image shows a hypoechoic lesion with heterogeneous echogenicity. (d) Medium-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows features of a malignant phyllodes tumor, with hypercellular stromal overgrowth that includes scarce benign epithelial cells and abundant spindle cells, but not the typical leaflike appearance.

 

View larger version (74K): [in a new window]   Figure 12b.  (a, b) Left mediolateral oblique magnification (a) and coned-down exaggerated craniocaudal-lateral magnification (b) views obtained at mammography in a 28-year-old patient show a very large oval-shaped high-density mass in a posterior location that extends to the pectoralis major muscle. (c) US image shows a hypoechoic lesion with heterogeneous echogenicity. (d) Medium-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows features of a malignant phyllodes tumor, with hypercellular stromal overgrowth that includes scarce benign epithelial cells and abundant spindle cells, but not the typical leaflike appearance.

 

View larger version (107K): [in a new window]   Figure 12c.  (a, b) Left mediolateral oblique magnification (a) and coned-down exaggerated craniocaudal-lateral magnification (b) views obtained at mammography in a 28-year-old patient show a very large oval-shaped high-density mass in a posterior location that extends to the pectoralis major muscle. (c) US image shows a hypoechoic lesion with heterogeneous echogenicity. (d) Medium-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows features of a malignant phyllodes tumor, with hypercellular stromal overgrowth that includes scarce benign epithelial cells and abundant spindle cells, but not the typical leaflike appearance.

 

View larger version (221K): [in a new window]   Figure 12d.  (a, b) Left mediolateral oblique magnification (a) and coned-down exaggerated craniocaudal-lateral magnification (b) views obtained at mammography in a 28-year-old patient show a very large oval-shaped high-density mass in a posterior location that extends to the pectoralis major muscle. (c) US image shows a hypoechoic lesion with heterogeneous echogenicity. (d) Medium-power photomicrograph (hematoxylin-eosin stain) of a biopsy specimen shows features of a malignant phyllodes tumor, with hypercellular stromal overgrowth that includes scarce benign epithelial cells and abundant spindle cells, but not the typical leaflike appearance.

 

View larger version (87K): [in a new window]   Figure 13.  Right mediolateral oblique mammographic view, obtained in a 53-year-old patient with a palpable mass, depicts an isodense circumscribed lesion (circular area that surrounds the white dot), a finding suggestive of a fibroadenoma. However, the results of pathologic analysis indicated sclerosing lobular hyperplasia.

 

View larger version (75K): [in a new window]   Figure 14a.  (a) Right craniocaudal mammographic view, obtained in a 35-year-old patient with type 1 diabetes, a palpable mass in the right breast, and a history of prior benign biopsy, shows dense breast parenchyma without a focal mass. (b) US image shows a dense acoustic shadow at the site of the palpable mass. Results of pathologic analysis confirmed the presence of diabetic fibrous mastopathy.

 

View larger version (135K): [in a new window]   Figure 14b.  (a) Right craniocaudal mammographic view, obtained in a 35-year-old patient with type 1 diabetes, a palpable mass in the right breast, and a history of prior benign biopsy, shows dense breast parenchyma without a focal mass. (b) US image shows a dense acoustic shadow at the site of the palpable mass. Results of pathologic analysis confirmed the presence of diabetic fibrous mastopathy.

 

View larger version (114K): [in a new window]   Figure 15a.  (a, b) Left craniocaudal (a) and mediolateral (b) views, obtained in a 40-year-old patient with type 1 diabetes and a palpable mass in the subareolar area of the left breast, show a very dense breast parenchyma with a focal area of high density at the site of the palpable mass (dot). (c) US image shows a dense acoustic shadow in the same area, a finding suggestive of diabetic fibrous mastopathy. (d, e) Low-power (d) and high-power (e) photomicrographs (hematoxylin-eosin stain) show extensive perivascular infiltrate of mature lymphocytes, as well as a markedly dense fibrous stroma, findings characteristic of diabetic fibrous mastopathy.

 

View larger version (58K): [in a new window]   Figure 15b.  (a, b) Left craniocaudal (a) and mediolateral (b) views, obtained in a 40-year-old patient with type 1 diabetes and a palpable mass in the subareolar area of the left breast, show a very dense breast parenchyma with a focal area of high density at the site of the palpable mass (dot). (c) US image shows a dense acoustic shadow in the same area, a finding suggestive of diabetic fibrous mastopathy. (d, e) Low-power (d) and high-power (e) photomicrographs (hematoxylin-eosin stain) show extensive perivascular infiltrate of mature lymphocytes, as well as a markedly dense fibrous stroma, findings characteristic of diabetic fibrous mastopathy.

 

View larger version (120K): [in a new window]   Figure 15c.  (a, b) Left craniocaudal (a) and mediolateral (b) views, obtained in a 40-year-old patient with type 1 diabetes and a palpable mass in the subareolar area of the left breast, show a very dense breast parenchyma with a focal area of high density at the site of the palpable mass (dot). (c) US image shows a dense acoustic shadow in the same area, a finding suggestive of diabetic fibrous mastopathy. (d, e) Low-power (d) and high-power (e) photomicrographs (hematoxylin-eosin stain) show extensive perivascular infiltrate of mature lymphocytes, as well as a markedly dense fibrous stroma, findings characteristic of diabetic fibrous mastopathy.

 

View larger version (206K): [in a new window]   Figure 15d.  (a, b) Left craniocaudal (a) and mediolateral (b) views, obtained in a 40-year-old patient with type 1 diabetes and a palpable mass in the subareolar area of the left breast, show a very dense breast parenchyma with a focal area of high density at the site of the palpable mass (dot). (c) US image shows a dense acoustic shadow in the same area, a finding suggestive of diabetic fibrous mastopathy. (d, e) Low-power (d) and high-power (e) photomicrographs (hematoxylin-eosin stain) show extensive perivascular infiltrate of mature lymphocytes, as well as a markedly dense fibrous stroma, findings characteristic of diabetic fibrous mastopathy.

 

View larger version (182K): [in a new window]   Figure 15e.  (a, b) Left craniocaudal (a) and mediolateral (b) views, obtained in a 40-year-old patient with type 1 diabetes and a palpable mass in the subareolar area of the left breast, show a very dense breast parenchyma with a focal area of high density at the site of the palpable mass (dot). (c) US image shows a dense acoustic shadow in the same area, a finding suggestive of diabetic fibrous mastopathy. (d, e) Low-power (d) and high-power (e) photomicrographs (hematoxylin-eosin stain) show extensive perivascular infiltrate of mature lymphocytes, as well as a markedly dense fibrous stroma, findings characteristic of diabetic fibrous mastopathy.

 

View larger version (103K): [in a new window]   Figure 16a.  (a) Left spot craniocaudal view obtained at screening mammography in a 47-year-old patient shows a focal area (dot) with asymmetric density in the upper outer quadrant. (b) Medium-power photomicrograph (hematoxylin-eosin stain) of specimen obtained at stereotactic biopsy shows stromal fibrosis, with thick collagenous bundles (arrow) and dense periductal stroma, as well as fibrous stroma with normal density (left portion of image).

 

View larger version (181K): [in a new window]   Figure 16b.  (a) Left spot craniocaudal view obtained at screening mammography in a 47-year-old patient shows a focal area (dot) with asymmetric density in the upper outer quadrant. (b) Medium-power photomicrograph (hematoxylin-eosin stain) of specimen obtained at stereotactic biopsy shows stromal fibrosis, with thick collagenous bundles (arrow) and dense periductal stroma, as well as fibrous stroma with normal density (left portion of image).

 

View larger version (68K): [in a new window]   Figure 17a.  (a) Right mediolateral oblique spot magnification view obtained at routine mammography in a 61-year-old woman shows a focal area of asymmetric density not observed at previous screening mammographic examinations. (b) US image shows a hypoechoic area with inhomogeneous echogenicity. (c) High-power photomicrograph (hematoxylin-eosin stain) of biopsy specimen shows features of pseudoangiomatous stromal hyperplasia, including a diffuse network of spaces in the collagenous stroma and anastomosing slitlike channels outlined by myofibroblasts.

 

View larger version (118K): [in a new window]   Figure 17b.  (a) Right mediolateral oblique spot magnification view obtained at routine mammography in a 61-year-old woman shows a focal area of asymmetric density not observed at previous screening mammographic examinations. (b) US image shows a hypoechoic area with inhomogeneous echogenicity. (c) High-power photomicrograph (hematoxylin-eosin stain) of biopsy specimen shows features of pseudoangiomatous stromal hyperplasia, including a diffuse network of spaces in the collagenous stroma and anastomosing slitlike channels outlined by myofibroblasts.

 

View larger version (218K): [in a new window]   Figure 17c.  (a) Right mediolateral oblique spot magnification view obtained at routine mammography in a 61-year-old woman shows a focal area of asymmetric density not observed at previous screening mammographic examinations. (b) US image shows a hypoechoic area with inhomogeneous echogenicity. (c) High-power photomicrograph (hematoxylin-eosin stain) of biopsy specimen shows features of pseudoangiomatous stromal hyperplasia, including a diffuse network of spaces in the collagenous stroma and anastomosing slitlike channels outlined by myofibroblasts.

 

View larger version (98K): [in a new window]   Figure 18.  Right mediolateral oblique mammographic view, obtained in a 72-year-old woman with a new fixed palpable mass in the inframammary crease area in the right breast, shows a round well-defined high-density lesion with a posterior and inferior location. The lesion appeared solid, with homogeneous hyperechogenicity at US. Results of pathologic analysis indicated a desmoid tumor or fibromatosis.

 

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