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Mrozin md BENIGN MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.

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Presentation on theme: "Mrozin md BENIGN MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers."— Presentation transcript:

1 mrozin md BENIGN MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers

2 mrozin md Benign Masses I.Fibroadenoma II.Fibroadenoma variants : complex FA tubular adenoma, lactating adenoma III.Phylloides Tumor IV.Hamartoma V.Lipoma VI.Focal Fibrosis VII.Diabetic mastopathy VIII.Fibrocystic change

3 mrozin md I. Fibroadenoma Arise from a single TDLU and contain both stromal (fibroma) & epithelial (adenoma) elements Edge is pushing not infiltrating & becomes encapsulated by compressed breast tissue FAs with cysts, apocrine metaplasia, or sclerosing adenosis are called COMPLEX

4 mrozin md FA – cont. Peak incidence – yr & again yr Usually 2-3 cm but giant FA & juvenile FA can grow to 10 cm Estrogen stimulation is important so most common when unopposed (anovulatory) i.e.. in adolescence and perimenopause Multiple in 25% also bilateral

5 mrozin md FA – sonographic appearance Oval, lobulated Circumscribed with echogenic capsule Parallel Iso or hypoechoic Normal or enhanced transmission with edge shadows Tiny ones (<1cm) may be round & cant DD from a complex cyst May mimic duct extension

6 mrozin md oval lobulated irregular

7 mrozin md isoechogenic hypoechogenic

8 mrozin md Calcifications in FA

9 mrozin md Ca++ FA in pathology

10 mrozin md FA – cont. Wide variability in histologic composition Wide variability in sonographic appearance Bilateral multiple FAs up to 10 nodules in each breast no need to Bx all of them new ones will almost always develop need 6 mo. F/U

11 mrozin md II. FA variants – Complex FA The epithelial components undergo proliferative change and we may see: sclerosing adenosis, cysts, apocrine metaplasia, amorphous calcifications About 20% of all FAs are complex ! (-) FHx increases risk for CA 3x (+) FHx increases risk for CA 4x Risk is generalized for the whole of both breasts.

12 mrozin md II. FA variants – Complex FA The diagnosis is histological U/S: may see internal cysts or heterogeneous echo pattern Seen at older age – median age 47 yrs Only 1.5% contained a CA AJR:2008;190:

13 mrozin md Complex FAs cysts & sclerosis

14 mrozin md II. FA variants – Tubular Adenoma & Lactating Adenoma Almost pure epithelial growth with very little or NO stromal component Tubular adenoma is very rare Lactating adenoma is common during pregnancy (mainly 3 rd trimester) and lactation

15 mrozin md II. FA variants – Tubular Adenoma & Lactating Adenoma Lactating adenoma may arise de novo, from a FA or from a tubular adenoma U/S: oval, spindle shaped, parallel, hypo-hyperechoic, enhancement, Doppler (+), microlobulated

16 mrozin md spindle shaped microlobulated Tubular adenomas

17 mrozin md hyper hypo IDC-Grade 3 Lactating adenomas

18 mrozin md III. Phylloides Tumor Rare – peak at yr but can occur in teenagers Very rapid growth – up to 15 cm 2/3 benign 1/3 malignant Mix of very cellular stromal and epithelial elements U/S: oval, well circumscribed, capsule, hypo, enhancement, cystic slits

19 mrozin md Phylloides with cystic clefts

20 mrozin md The faces of phylloides

21 mrozin md IV. Hamartoma Localized overgrowth of fibrous, epithelial and fatty elements = normal breast tissue Other names: adenolipofibroma, lipoadenofibroma, fibroadenolipoma U/S: oval, very heterogeneous, capsule, parallel

22 mrozin md Classic hamartoma

23 mrozin md Hamartoma on mammo & CT

24 mrozin md V. Lipoma Overgrowth of fatty tissue They are actually in the skin NOT in the breast May grow up to 20 cm !!!! U/S: completely isoechoic with the other fat lobules or mildly hyperechoic, soft and compressible

25 mrozin md hyper iso fat necrosis

26 mrozin md

27 VI. Focal Fibrosis FIBROUS MASTOPATHY Can cause tender/non-tender palpable lump May see focal asymmetry on mammo – UOQ

28 mrozin md VI. Focal Fibrosis Pathology: dense stromal fibrous tissue without cells U/S: purely hyperechoic & homogeneous, no capsule tapers into Coopers ligaments so can be teardrop or spindle shaped BEWARE: DD with echogenic rim !!!

29 mrozin md MUST have mammographic correlation

30 mrozin md VII. Diabetic Mastopathy Occurs in premenopausal women Most have Type I diabetes before the age of 20 yr Usually a very hard palpable lump May be multifocal, multicentric and bilateral

31 mrozin md VII. Diabetic Mastopathy Mammo: non specific asymmetry U/S: VERY SCARY !!!!!! Ill-defined, angular, microlobulated, hypoechoic, not parallel, intense shadowing ALL go to Bx.

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34 VIII. Fibrocystic Change Huge spectrum from all the types of cystic change to benign proliferation forming a solid nodule Adenosis & Sclerosing Adenosis: TDLUs enlarge and increase in number normal lobules – 2 mm adenosis – 5 mm Mammo: focal asymmetry, masses, starry night calcifications U/S: extremely varied

35 mrozin md

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37 adenosis with cysts hypoechoic adenosis in hyper glandular tissue adenosis with amorphous ca++

38 mrozin md Adenosis and blunt duct adenosis

39 mrozin md adenosis blunt duct adenosis

40 mrozin md starry night of sclerosing adenosis

41 mrozin md The faces of sclerosing adenois distended terminal lobule branching central fibrosis

42 mrozin md Sclerosing adenosis with spiculation & halo

43 mrozin md Sclerosing adenosis with ca++

44 mrozin md Remember algorithm and technique Know your anatomy Must correlate with mammo & clinical presentation Huge overlap of findings Better than doing mammograms all day!

45 mrozin md


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