DOI: 10.1148/rg.27si075505
Radiologic Evaluation of Breast Disorders Related to Pregnancy and Lactation1
Josep M. Sabate, MD,
Montse Clotet, MD,
Sofia Torrubia, MD,
Antonio Gomez, MD,
Ruben Guerrero, MD,
Pilar de Las Heras, MD, and
Enrique Lerma, MD
1 From the Unit of Breast Imaging, Department of Diagnostic Radiology (J.M.S., M.C., S.T., R.G.), and the Department of Pathology (E.L.), Hospital de la Santa Creu i Sant Pau, Avda Sant Antoni Maria Claret 167, 08025 Barcelona, Spain; and the Departments of Breast Imaging (J.M.S., A.G.) and Breast Pathology (P.L.), CEDIMMA, Barcelona, Spain. Recipient of a Certificate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received February 21, 2007; revision requested April 5 and received May 22; accepted May 30. All authors have no financial relationships to disclose.
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Figure 1a. (a, b) Pathologic changes during pregnancy (gestational hyperplasia). (a) Photomicrograph (original magnification, x20; hematoxylin-eosin [H-E] stain) obtained during the 1st trimester of pregnancy shows slight acinar proliferation with minimal secretory change. Involution of the fibrofatty stroma is also noted. (b) Photomicrograph (original magnification, x40; H-E stain) obtained during the 3rd trimester of pregnancy reveals intense lobular proliferation. The cells appear enlarged with increased cytoplasm and enlarged nuclei. Note also the dramatic stromal involution and increased vascularity (arrows). (c) Pathologic changes during lactation (secretory hyperplasia). Photomicrograph (original magnification, x40; H-E stain) shows notable growth and distention of lobules, with cells appearing markedly enlarged with vacuolated cytoplasm. Nuclei are more enlarged, and milk is retained in the ducts (*).
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Figure 1b. (a, b) Pathologic changes during pregnancy (gestational hyperplasia). (a) Photomicrograph (original magnification, x20; hematoxylin-eosin [H-E] stain) obtained during the 1st trimester of pregnancy shows slight acinar proliferation with minimal secretory change. Involution of the fibrofatty stroma is also noted. (b) Photomicrograph (original magnification, x40; H-E stain) obtained during the 3rd trimester of pregnancy reveals intense lobular proliferation. The cells appear enlarged with increased cytoplasm and enlarged nuclei. Note also the dramatic stromal involution and increased vascularity (arrows). (c) Pathologic changes during lactation (secretory hyperplasia). Photomicrograph (original magnification, x40; H-E stain) shows notable growth and distention of lobules, with cells appearing markedly enlarged with vacuolated cytoplasm. Nuclei are more enlarged, and milk is retained in the ducts (*).
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Figure 1c. (a, b) Pathologic changes during pregnancy (gestational hyperplasia). (a) Photomicrograph (original magnification, x20; hematoxylin-eosin [H-E] stain) obtained during the 1st trimester of pregnancy shows slight acinar proliferation with minimal secretory change. Involution of the fibrofatty stroma is also noted. (b) Photomicrograph (original magnification, x40; H-E stain) obtained during the 3rd trimester of pregnancy reveals intense lobular proliferation. The cells appear enlarged with increased cytoplasm and enlarged nuclei. Note also the dramatic stromal involution and increased vascularity (arrows). (c) Pathologic changes during lactation (secretory hyperplasia). Photomicrograph (original magnification, x40; H-E stain) shows notable growth and distention of lobules, with cells appearing markedly enlarged with vacuolated cytoplasm. Nuclei are more enlarged, and milk is retained in the ducts (*).
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Figure 2a. Mammographic changes during lactation. (a) Baseline mammogram obtained before pregnancy shows minimal scattered fibroglandular densities with glandular components lower than 50%, type 2 American College of Radiology (ACR) classification. (b) Mammogram obtained during lactation shows a marked diffuse increase in density.
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Figure 2b. Mammographic changes during lactation. (a) Baseline mammogram obtained before pregnancy shows minimal scattered fibroglandular densities with glandular components lower than 50%, type 2 American College of Radiology (ACR) classification. (b) Mammogram obtained during lactation shows a marked diffuse increase in density.
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Figure 4a. US changes during lactation. (a) US image reveals diffuse enlargement of the glandular component with diffuse hyperechogenicity. The latter finding is related to the production of milk, which is rich in fat. (b) US image shows a prominent ductal system, a characteristic feature of lactation due to milk secretion. (c) Color Doppler US image (shown in black and white) reveals increased vascularity (arrow). This finding can also be seen during pregnancy but is more marked during lactation.
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Figure 4b. US changes during lactation. (a) US image reveals diffuse enlargement of the glandular component with diffuse hyperechogenicity. The latter finding is related to the production of milk, which is rich in fat. (b) US image shows a prominent ductal system, a characteristic feature of lactation due to milk secretion. (c) Color Doppler US image (shown in black and white) reveals increased vascularity (arrow). This finding can also be seen during pregnancy but is more marked during lactation.
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Figure 4c. US changes during lactation. (a) US image reveals diffuse enlargement of the glandular component with diffuse hyperechogenicity. The latter finding is related to the production of milk, which is rich in fat. (b) US image shows a prominent ductal system, a characteristic feature of lactation due to milk secretion. (c) Color Doppler US image (shown in black and white) reveals increased vascularity (arrow). This finding can also be seen during pregnancy but is more marked during lactation.
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Figure 5a. Microcalcifications secondary to secretory hyperplasia during lactation in a 35-year-old woman. (a) Image from a mammographic study performed for nonrelevant breast pain shows regional foci of suspect microcalcifications (circled), a finding that led to prompt core biopsy. Note the presence of both linear and punctate microcalcifications, the former related to ductal hyperplasia and the latter to lobular growth. (b) Photomicrograph (original magnification, x10; H-E stain) demonstrates the characteristic features of secretory hyperplasia.
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Figure 5b. Microcalcifications secondary to secretory hyperplasia during lactation in a 35-year-old woman. (a) Image from a mammographic study performed for nonrelevant breast pain shows regional foci of suspect microcalcifications (circled), a finding that led to prompt core biopsy. Note the presence of both linear and punctate microcalcifications, the former related to ductal hyperplasia and the latter to lobular growth. (b) Photomicrograph (original magnification, x10; H-E stain) demonstrates the characteristic features of secretory hyperplasia.
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Figure 6a. Intraductal carcinoma in a 31-year-old woman who presented with bloody nipple discharge in the 3rd trimester of pregnancy. (a) Mammogram obtained with abdominal shielding reveals extensive suspect foci of linear and pleomorphic microcalcifications (arrows) with a segmental distribution (circled). Galactography was performed because the bloody discharge was limited to one duct. (b) Galactogram shows multiple small, irregular intraductal filling defects (arrows) secondary to neoplastic proliferation involving the same pathologic lobe that was seen at mammography.
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Figure 6b. Intraductal carcinoma in a 31-year-old woman who presented with bloody nipple discharge in the 3rd trimester of pregnancy. (a) Mammogram obtained with abdominal shielding reveals extensive suspect foci of linear and pleomorphic microcalcifications (arrows) with a segmental distribution (circled). Galactography was performed because the bloody discharge was limited to one duct. (b) Galactogram shows multiple small, irregular intraductal filling defects (arrows) secondary to neoplastic proliferation involving the same pathologic lobe that was seen at mammography.
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Figure 7. Papilloma in a young lactating woman who presented with bloody nipple discharge. Galactogram reveals a small filling defect (arrow). Surgical biopsy showed that this finding represented a papilloma.
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Figure 8a. Pseudolipoma type galactocele. (a) Mammogram reveals an oval circumscribed mass whose radiolucency indicates a high fat content. Such a mass is mammographically indistinguishable from a true lipoma. (b) US image shows a circumscribed echogenic mass mimicking a solid lesion. Note the intense posterior enhancement (arrows), which suggests a cystic mass with a nonwater content (complicated cyst). In the appropriate clinical setting, galactocele can be suspected and can easily be confirmed with fine-needle aspiration.
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Figure 8b. Pseudolipoma type galactocele. (a) Mammogram reveals an oval circumscribed mass whose radiolucency indicates a high fat content. Such a mass is mammographically indistinguishable from a true lipoma. (b) US image shows a circumscribed echogenic mass mimicking a solid lesion. Note the intense posterior enhancement (arrows), which suggests a cystic mass with a nonwater content (complicated cyst). In the appropriate clinical setting, galactocele can be suspected and can easily be confirmed with fine-needle aspiration.
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Figure 9a. Cystic mass with fat-fluid level galactocele. (a) Mammogram reveals an oval circumscribed mass with the characteristic fat-fluid level (arrows). In this type of galactocele, the milk content is fresh and fluid, allowing the fat to rise and the heavier water content to remain in the lower portion of the cyst. (b) US image also demonstrates the fat-fluid level (long arrows), with typical high and low echogenicity. Note that the fatty component has risen and occupies the upper (nondependent) portion of the cyst, whereas the heavier water content remains in the lower (dependent) portion. Note also the clot of fatty milk ("cream") (short arrow) floating in the nondependent portion of the cyst owing to its intermediate density.
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Figure 9b. Cystic mass with fat-fluid level galactocele. (a) Mammogram reveals an oval circumscribed mass with the characteristic fat-fluid level (arrows). In this type of galactocele, the milk content is fresh and fluid, allowing the fat to rise and the heavier water content to remain in the lower portion of the cyst. (b) US image also demonstrates the fat-fluid level (long arrows), with typical high and low echogenicity. Note that the fatty component has risen and occupies the upper (nondependent) portion of the cyst, whereas the heavier water content remains in the lower (dependent) portion. Note also the clot of fatty milk ("cream") (short arrow) floating in the nondependent portion of the cyst owing to its intermediate density.
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Figure 10a. Pseudohamartoma type galactocele. (a) Mammogram shows an oval circumscribed mass with characteristic heterogeneous density due to the presence of fat radiolucencies in the mass (arrows). (b) US image shows the mass, which consists of a mixture of hypoechogenic and hyperechogenic (*) areas.
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Figure 10b. Pseudohamartoma type galactocele. (a) Mammogram shows an oval circumscribed mass with characteristic heterogeneous density due to the presence of fat radiolucencies in the mass (arrows). (b) US image shows the mass, which consists of a mixture of hypoechogenic and hyperechogenic (*) areas.
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Figure 11. Infected galactocele in a young lactating woman who presented with a painful, palpable breast mass and discrete clinical signs of inflammation. US image shows a complex cystic mass. Fine-needle aspiration revealed purulent and milky material, thereby confirming the clinically suspected diagnosis (infected galactocele). Note that this US finding can be mistaken for a cavitating carcinoma.
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Figure 12a. Puerperal mastitis with abscess formation secondary to Streptococcus infection in a 32-year-old lactating woman with a palpable mass. (a) Mammogram shows a large lobular mass with obscured, indistinct margins (arrows) corresponding to the palpable mass. Note the diffuse signs of inflammation involving large portions of the breast. (b) US image reveals a large, complex cystic mass. Purulent material was obtained at fine-needle aspiration. The findings on both images can be mistaken for malignancy.
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Figure 12b. Puerperal mastitis with abscess formation secondary to Streptococcus infection in a 32-year-old lactating woman with a palpable mass. (a) Mammogram shows a large lobular mass with obscured, indistinct margins (arrows) corresponding to the palpable mass. Note the diffuse signs of inflammation involving large portions of the breast. (b) US image reveals a large, complex cystic mass. Purulent material was obtained at fine-needle aspiration. The findings on both images can be mistaken for malignancy.
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Figure 13a. Puerperal mastitis secondary to S aureus infection. (a) Transverse US image shows a complex heterogeneous mass (arrows), a finding that represents a subareolar abscess. (b) Longitudinal US image shows hypoechoic fluid collections (arrows) surrounding large subareolar ducts (periductitis).
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Figure 13b. Puerperal mastitis secondary to S aureus infection. (a) Transverse US image shows a complex heterogeneous mass (arrows), a finding that represents a subareolar abscess. (b) Longitudinal US image shows hypoechoic fluid collections (arrows) surrounding large subareolar ducts (periductitis).
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Figure 14a. Granulomatous mastitis in a 35-year-old woman after pregnancy. (a) US image reveals a heterogeneous hypoechoic mass with irregular margins and tubular structures (arrows) surrounded by hyperechoic boundaries. (b) Photomicrograph (original magnification, x20, H-E stain) shows lobular lymphocytic inflammatory infiltrate (arrows) with abundant multinucleate histiocytes (arrowheads). Recently, Corynebacterium has been implicated in the pathogenesis of granulomatous mastitis.
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Figure 14b. Granulomatous mastitis in a 35-year-old woman after pregnancy. (a) US image reveals a heterogeneous hypoechoic mass with irregular margins and tubular structures (arrows) surrounded by hyperechoic boundaries. (b) Photomicrograph (original magnification, x20, H-E stain) shows lobular lymphocytic inflammatory infiltrate (arrows) with abundant multinucleate histiocytes (arrowheads). Recently, Corynebacterium has been implicated in the pathogenesis of granulomatous mastitis.
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Figure 15a. Juvenile papillomatosis of the breast in a 33-year-old lactating woman who presented with a painless palpable mass 2 months after pregnancy. The diagnosis was based on the analysis of core biopsy specimens and was subsequently confirmed after surgical excision. (a) US image shows an irregular hypoechoic mass filled with multiple cysts of varying size, findings that are typical in juvenile papillomatosis. (b) Photomicrograph (original magnification, x5; H-E stain) of a core biopsy specimen reveals multiple cysts and varying degrees of ductal hyperplasia. Some of the cysts demonstrate hyperplastic epithelium. (c) Axial contrast-enhanced dynamic subtraction T1-weighted MR image demonstrates areas of clumped enhancement with a segmental distribution. The use of MR imaging is not recommended during lactation, but in some situations (such as this one) it can be helpful for defining disease extent. The patient underwent surgical excision after the cessation of lactation. Adequate surgical margins were obtained to avoid recurrences. Foci of malignancy, which are seen in about 10% of patients with juvenile papillomatosis (59), were excluded.
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Figure 15b. Juvenile papillomatosis of the breast in a 33-year-old lactating woman who presented with a painless palpable mass 2 months after pregnancy. The diagnosis was based on the analysis of core biopsy specimens and was subsequently confirmed after surgical excision. (a) US image shows an irregular hypoechoic mass filled with multiple cysts of varying size, findings that are typical in juvenile papillomatosis. (b) Photomicrograph (original magnification, x5; H-E stain) of a core biopsy specimen reveals multiple cysts and varying degrees of ductal hyperplasia. Some of the cysts demonstrate hyperplastic epithelium. (c) Axial contrast-enhanced dynamic subtraction T1-weighted MR image demonstrates areas of clumped enhancement with a segmental distribution. The use of MR imaging is not recommended during lactation, but in some situations (such as this one) it can be helpful for defining disease extent. The patient underwent surgical excision after the cessation of lactation. Adequate surgical margins were obtained to avoid recurrences. Foci of malignancy, which are seen in about 10% of patients with juvenile papillomatosis (59), were excluded.
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Figure 15c. Juvenile papillomatosis of the breast in a 33-year-old lactating woman who presented with a painless palpable mass 2 months after pregnancy. The diagnosis was based on the analysis of core biopsy specimens and was subsequently confirmed after surgical excision. (a) US image shows an irregular hypoechoic mass filled with multiple cysts of varying size, findings that are typical in juvenile papillomatosis. (b) Photomicrograph (original magnification, x5; H-E stain) of a core biopsy specimen reveals multiple cysts and varying degrees of ductal hyperplasia. Some of the cysts demonstrate hyperplastic epithelium. (c) Axial contrast-enhanced dynamic subtraction T1-weighted MR image demonstrates areas of clumped enhancement with a segmental distribution. The use of MR imaging is not recommended during lactation, but in some situations (such as this one) it can be helpful for defining disease extent. The patient underwent surgical excision after the cessation of lactation. Adequate surgical margins were obtained to avoid recurrences. Foci of malignancy, which are seen in about 10% of patients with juvenile papillomatosis (59), were excluded.
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Figure 16a. Lactating adenoma. (a) Mammogram shows an oval circumscribed mass (arrows) with radiolucent central areas (arrowheads), some of which have a linear appearance. (b) US image demonstrates the heterogeneous echotexture of the tumor, which has central hyperechogenic areas (arrows). Both the radiolucent and the hyperechogenic areas correlate with the fat content of the milk produced by the tumor. Aspiration of milk is consistent with but not definitive for the diagnosis of galactocele; milk can also be obtained in lactating adenoma or in fibroadenoma with secretory changes. (c) Photomicrograph (original magnification, x20; Papanicolaou stain) reveals some aggregate cells (arrows) in the setting of lactational change. (d) Photomicrograph (original magnification, x40; H-E stain) of the core biopsy specimen demonstrates lactating adenoma.
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Figure 16b. Lactating adenoma. (a) Mammogram shows an oval circumscribed mass (arrows) with radiolucent central areas (arrowheads), some of which have a linear appearance. (b) US image demonstrates the heterogeneous echotexture of the tumor, which has central hyperechogenic areas (arrows). Both the radiolucent and the hyperechogenic areas correlate with the fat content of the milk produced by the tumor. Aspiration of milk is consistent with but not definitive for the diagnosis of galactocele; milk can also be obtained in lactating adenoma or in fibroadenoma with secretory changes. (c) Photomicrograph (original magnification, x20; Papanicolaou stain) reveals some aggregate cells (arrows) in the setting of lactational change. (d) Photomicrograph (original magnification, x40; H-E stain) of the core biopsy specimen demonstrates lactating adenoma.
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Figure 16c. Lactating adenoma. (a) Mammogram shows an oval circumscribed mass (arrows) with radiolucent central areas (arrowheads), some of which have a linear appearance. (b) US image demonstrates the heterogeneous echotexture of the tumor, which has central hyperechogenic areas (arrows). Both the radiolucent and the hyperechogenic areas correlate with the fat content of the milk produced by the tumor. Aspiration of milk is consistent with but not definitive for the diagnosis of galactocele; milk can also be obtained in lactating adenoma or in fibroadenoma with secretory changes. (c) Photomicrograph (original magnification, x20; Papanicolaou stain) reveals some aggregate cells (arrows) in the setting of lactational change. (d) Photomicrograph (original magnification, x40; H-E stain) of the core biopsy specimen demonstrates lactating adenoma.
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Figure 16d. Lactating adenoma. (a) Mammogram shows an oval circumscribed mass (arrows) with radiolucent central areas (arrowheads), some of which have a linear appearance. (b) US image demonstrates the heterogeneous echotexture of the tumor, which has central hyperechogenic areas (arrows). Both the radiolucent and the hyperechogenic areas correlate with the fat content of the milk produced by the tumor. Aspiration of milk is consistent with but not definitive for the diagnosis of galactocele; milk can also be obtained in lactating adenoma or in fibroadenoma with secretory changes. (c) Photomicrograph (original magnification, x20; Papanicolaou stain) reveals some aggregate cells (arrows) in the setting of lactational change. (d) Photomicrograph (original magnification, x40; H-E stain) of the core biopsy specimen demonstrates lactating adenoma.
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Figure 17a. Growing fibroadenoma. (a) US image obtained in a 32-year-old pregnant woman reveals a fibroadenoma with a prominent ductal pattern (arrows). Gestational fibroadenomas may undergo proliferative changes under hormonal stimulation, leading to manifestations resembling those of complex fibroadenomas. (b) Transverse US images obtained in a 28-year-old pregnant woman show a fibroadenoma containing large cysts (arrows). (c) Color Doppler US image obtained in a 38-year-old pregnant woman shows a fibroadenoma with increased vascularity.
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Figure 17b. Growing fibroadenoma. (a) US image obtained in a 32-year-old pregnant woman reveals a fibroadenoma with a prominent ductal pattern (arrows). Gestational fibroadenomas may undergo proliferative changes under hormonal stimulation, leading to manifestations resembling those of complex fibroadenomas. (b) Transverse US images obtained in a 28-year-old pregnant woman show a fibroadenoma containing large cysts (arrows). (c) Color Doppler US image obtained in a 38-year-old pregnant woman shows a fibroadenoma with increased vascularity.
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Figure 17c. Growing fibroadenoma. (a) US image obtained in a 32-year-old pregnant woman reveals a fibroadenoma with a prominent ductal pattern (arrows). Gestational fibroadenomas may undergo proliferative changes under hormonal stimulation, leading to manifestations resembling those of complex fibroadenomas. (b) Transverse US images obtained in a 28-year-old pregnant woman show a fibroadenoma containing large cysts (arrows). (c) Color Doppler US image obtained in a 38-year-old pregnant woman shows a fibroadenoma with increased vascularity.
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Figure 18a. Fibroadenoma with infarction in a nonlactating 35-year-old woman who presented with sudden pain and swelling in the upper portion of the left breast 4 months after delivery. (a) Baseline US image obtained at the time of diagnosis before pregnancy reveals an oval, slightly lobulated mass with circumscribed margins. Note the posterior acoustic enhancement (arrows). (b) US image reveals a round heterogeneous mass with irregular margins representing an infarcted fibroadenoma. Note the posterior acoustic shadowing (arrows). (c) Photomicrograph (original magnification, x10; H-E stain) shows the fibroadenoma with large areas of hyalinization (*) secondary to infarction. The suspicious US findings led to excision of the mass, which proved to be infarcted fibroadenoma.
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Figure 18b. Fibroadenoma with infarction in a nonlactating 35-year-old woman who presented with sudden pain and swelling in the upper portion of the left breast 4 months after delivery. (a) Baseline US image obtained at the time of diagnosis before pregnancy reveals an oval, slightly lobulated mass with circumscribed margins. Note the posterior acoustic enhancement (arrows). (b) US image reveals a round heterogeneous mass with irregular margins representing an infarcted fibroadenoma. Note the posterior acoustic shadowing (arrows). (c) Photomicrograph (original magnification, x10; H-E stain) shows the fibroadenoma with large areas of hyalinization (*) secondary to infarction. The suspicious US findings led to excision of the mass, which proved to be infarcted fibroadenoma.
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Figure 18c. Fibroadenoma with infarction in a nonlactating 35-year-old woman who presented with sudden pain and swelling in the upper portion of the left breast 4 months after delivery. (a) Baseline US image obtained at the time of diagnosis before pregnancy reveals an oval, slightly lobulated mass with circumscribed margins. Note the posterior acoustic enhancement (arrows). (b) US image reveals a round heterogeneous mass with irregular margins representing an infarcted fibroadenoma. Note the posterior acoustic shadowing (arrows). (c) Photomicrograph (original magnification, x10; H-E stain) shows the fibroadenoma with large areas of hyalinization (*) secondary to infarction. The suspicious US findings led to excision of the mass, which proved to be infarcted fibroadenoma.
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Figure 19a. Fibroadenoma with secretory hyperplasia and infarction in a nonlactating 42-year-old woman who presented with a painful, palpable mass 4 months after delivery. (a) Mammogram reveals a round circumscribed mass (dashed circle) with multiple suspect microcalcifications corresponding to the hyperplastic epithelium of secretory change. Within the solid circle is a magnified view of the mass. (b) Color Doppler US image shows a complex mass with a large cystic area (short arrows) corresponding to the infarcted or necrotic region and a solid area with increased vascularity (long arrows). The diagnosis was established with core biopsy and subsequently confirmed at surgical excision.
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Figure 19b. Fibroadenoma with secretory hyperplasia and infarction in a nonlactating 42-year-old woman who presented with a painful, palpable mass 4 months after delivery. (a) Mammogram reveals a round circumscribed mass (dashed circle) with multiple suspect microcalcifications corresponding to the hyperplastic epithelium of secretory change. Within the solid circle is a magnified view of the mass. (b) Color Doppler US image shows a complex mass with a large cystic area (short arrows) corresponding to the infarcted or necrotic region and a solid area with increased vascularity (long arrows). The diagnosis was established with core biopsy and subsequently confirmed at surgical excision.
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Figure 20. Fibroadenoma with lactational change 3 months after delivery in a 33-year-old woman. US image shows a round, heterogeneous circumscribed mass with mixed hypoechoic and hyperechoic areas. The hyperechogenic punctate central areas represent calcifications. Note also the posterior acoustic shadowing.
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Figure 21a. Inflammatory carcinoma during the 3rd trimester of pregnancy in a 35-year-old woman. (a) Mammogram shows a marked diffuse increase in parenchymal density with skin thickening (long arrows) and thickened trabeculae due to dilated lymphatic vessels (short arrows), the hallmarks of inflammatory carcinoma. (b) US image shows skin thickening (short arrows) and a network of hypoechoic and anechoic tubular structures (long arrows) representing enlarged lymphatic vessels. Note also the diffuse increase in parenchymal echogenicity (*). US can usually help guide biopsy if a mass is seen at US or if results of skin punch biopsy are nondiagnostic.
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Figure 21b. Inflammatory carcinoma during the 3rd trimester of pregnancy in a 35-year-old woman. (a) Mammogram shows a marked diffuse increase in parenchymal density with skin thickening (long arrows) and thickened trabeculae due to dilated lymphatic vessels (short arrows), the hallmarks of inflammatory carcinoma. (b) US image shows skin thickening (short arrows) and a network of hypoechoic and anechoic tubular structures (long arrows) representing enlarged lymphatic vessels. Note also the diffuse increase in parenchymal echogenicity (*). US can usually help guide biopsy if a mass is seen at US or if results of skin punch biopsy are nondiagnostic.
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Figure 22a. PABC in a nonlactating 38-year-old woman who presented with a large mass in the right breast 2 months after delivery. (a) Mammogram reveals a large lobular mass with obscured margins (arrows), although the mass is partially circumscribed. Note the suspect axillary node (*). (b) US image shows an irregular heterogeneous hypoechoic mass with indistinct margins (arrows) representing a histologically high-grade invasive ductal carcinoma.
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Figure 22b. PABC in a nonlactating 38-year-old woman who presented with a large mass in the right breast 2 months after delivery. (a) Mammogram reveals a large lobular mass with obscured margins (arrows), although the mass is partially circumscribed. Note the suspect axillary node (*). (b) US image shows an irregular heterogeneous hypoechoic mass with indistinct margins (arrows) representing a histologically high-grade invasive ductal carcinoma.
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Figure 23a. Medullary carcinoma in an asymptomatic nonlactating 38-year-old BRCA1 mutation carrier. The diagnosis was made with screening US 6 months after delivery. (a) US image reveals an 8-mm round circumscribed mass. The mass was not palpable and could not be visualized at mammography. (b) Photomicrograph (original magnification, x20; H-E stain) shows a medullary carcinoma with the characteristic histologically high-grade appearance. Several studies have found a high prevalence of medullary carcinomas in BRCA1 mutation carriers.
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Figure 23b. Medullary carcinoma in an asymptomatic nonlactating 38-year-old BRCA1 mutation carrier. The diagnosis was made with screening US 6 months after delivery. (a) US image reveals an 8-mm round circumscribed mass. The mass was not palpable and could not be visualized at mammography. (b) Photomicrograph (original magnification, x20; H-E stain) shows a medullary carcinoma with the characteristic histologically high-grade appearance. Several studies have found a high prevalence of medullary carcinomas in BRCA1 mutation carriers.
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Figure 24a. Microglandular adenosis in a nonlactating 27-year-old BRCA1 mutation carrier who presented with a palpable mass 6 months after delivery. (a) US image obtained directly over the lesion shows a 10-mm lobular mass with irregular margins at the anterior surface of the gland. (b) Photomicrograph (original magnification, x20; H-E stain) of the core biopsy specimen reveals poorly circumscribed nonlobulocentric proliferation of small glands surrounded by adipocytes. Results of mammography were negative. The diagnosis of microglandular adenosis was subsequently confirmed at surgical excision, and foci of malignancy were excluded. The latter finding has been reported in up to 23% of patients in the literature (82).
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Figure 24b. Microglandular adenosis in a nonlactating 27-year-old BRCA1 mutation carrier who presented with a palpable mass 6 months after delivery. (a) US image obtained directly over the lesion shows a 10-mm lobular mass with irregular margins at the anterior surface of the gland. (b) Photomicrograph (original magnification, x20; H-E stain) of the core biopsy specimen reveals poorly circumscribed nonlobulocentric proliferation of small glands surrounded by adipocytes. Results of mammography were negative. The diagnosis of microglandular adenosis was subsequently confirmed at surgical excision, and foci of malignancy were excluded. The latter finding has been reported in up to 23% of patients in the literature (82).
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Figure 25a. Pregnancy-related Burkitt lymphoma of the breast in a 29-year-old woman who presented with painful and rapid diffuse enlargement of both breasts 2 months after delivery. (a, b) Mediolateral oblique mammograms reveal a marked diffuse increase in parenchymal density in both breasts. (c) Photomicrograph (original magnification, x100; H-E stain) of the core biopsy specimen demonstrates Burkitt lymphoma.
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Figure 25b. Pregnancy-related Burkitt lymphoma of the breast in a 29-year-old woman who presented with painful and rapid diffuse enlargement of both breasts 2 months after delivery. (a, b) Mediolateral oblique mammograms reveal a marked diffuse increase in parenchymal density in both breasts. (c) Photomicrograph (original magnification, x100; H-E stain) of the core biopsy specimen demonstrates Burkitt lymphoma.
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Figure 25c. Pregnancy-related Burkitt lymphoma of the breast in a 29-year-old woman who presented with painful and rapid diffuse enlargement of both breasts 2 months after delivery. (a, b) Mediolateral oblique mammograms reveal a marked diffuse increase in parenchymal density in both breasts. (c) Photomicrograph (original magnification, x100; H-E stain) of the core biopsy specimen demonstrates Burkitt lymphoma.
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Copyright © 2007 by the Radiological Society of North America.
