Case of the Day from Dr. Vlahos
Breast
Elderly asymptomatic female patient at screening mammography
Diagnosis?
Answer and Discussion on next presentation Answer Slides
Breast
Answer Slides Author: J Vlahos
Right and Left Breast Craniocaudal Mammograms
Right and Left Breast Mediolateral Obliques
The craniocaudal projections demonstrate several smoothly marginated well defined nodules projected within the breast tissues bilaterally. The mediolateral oblique projections confirm that several of these “nodules” are very superficial at the dermis or subdermal level. Indeed reviewing the craniocaudal projections demonstrates that several lesions are particularly well marginated due to a surrounding crescent of air. This indicates a cutaneous nature.
Additional Imaging in Same Patient
Additional Imaging in Same Patient
Multiple small nodules are projected over the lungs and the subcutaneous tissues. A scoliosis of the thoracolumbar spine is also evident.
Neurofibromatosis
Well defined nodules are usually associated with benign breast etiologies. The presence of multiple nodules increases the probability of benign entities. These are classified as Breast Imaging Reporting and Data System (BI-RADS) category 2, benign findings, without the need for recall for further evaluation. Of 1440 cases of multiple bilateral breast lesions only 2 (0.14%) node negative breast cancers were identified 1 . Similar results have been replicated at ultrasound 2 . Multiple nodules are usually cysts, including minimally complicated cysts or oil cysts which can be recognized by their low density. Fibroadenomas can also be multiple or bilateral in 10-15% of cases. The presence of subdermal lesions raises considerations of sebaceous cysts and lipomas. Metastatic disease from melanoma or lymphoma can occasionally be a cause but is usually in the context of advanced disease elsewhere. When cutaneous extension is present the possibility of neurofibromatosis should be considered, particularly when the patient is asymptomatic.
References: 1 Leung JW, Sickles EA. Multiple bilateral masses detected on screening mammography: assessment of need for recall imaging. AJR Am J Roentgenol 2000;175(1):23–29 2 Berg WA et al. Multiple Bilateral Circumscribed Masses at Screening Breast US: Consider Annual Follow-up. Radiology 2013 268:3, 673-683
Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13Made with FlippingBook - professional solution for displaying marketing and sales documents online