Foreign body in the breast: multiple sewing needles / Corpo estranho no parênquima mamário: múltiplas agulhas

Needles embedded in the breast are an unusual situation. It is reported the possibility of developing an abscess and the risk of migration of the needles. We report the case of a 38 year old woman with approximately 25 needles inserted in her breasts, bilaterally. According to the patient, the insertion occurred during the episode of a recent physical aggression; however, the hypothesis of self-mutilation could not be ruled out. She also referred the withdrawal of some needles at home and tried a surgical resection of others. Physical examination of the breasts revealed bilateral bruising, located in the upper inner quadrant of the left breast and diffusely in the right breast. Ultrasound examination showed needles in both breasts, associated with a hyperechoic area between 5 and 6h of the right breast, corresponding to palpable clinical area. An X-ray and chest tomography also revealed the presence of several needles in the breasts. At mammography, multiple intra-mammary needles and lymph nodes were diffusely distributed through the parenchyma, bilaterally. After discussing with the patient about the diagnosis and therapeutic options, we opted for clinical follow-up. Currently, the patient has moderate acyclic mastalgia, and is on clinical follow up for 55 months

Agulhas inseridas no parênquima mamário constituem uma situação incomum, podendo haver ocorrência de abscessos e o risco de migração das agulhas. Descrevemos o caso de uma paciente do sexo feminino, de 38 anos de idade, diagnosticada com aproximadamente 25 agulhas de costura em suas mamas, bilateralmente. Segundo a paciente, a inserção ocorreu durante episódio de agressão física recente; porém, a hipótese de automutilação não pôde ser descartada. A paciente também referiu a retirada domiciliar de algumas agulhas e a tentativa de retirada em outro Serviço. Ao exame físico das mamas, evidenciava-se equimose bilateral, localizada no quadrante súpero-medial da mama esquerda e difusamente na mama direita. O exame ultrassonográfico evidenciou agulhas em ambas as mamas, associadas à área hiperecoica entre 5 e 6h da mama direita, correspondente a área clínica palpável. A radiografia e a tomografia de tórax visibilizaram a presença de vários corpos estranhos nas mamas, de aspecto metálico, compatíveis com agulhas. Após discussão com a paciente acerca do diagnóstico e das opções terapêuticas, optou-se por conduta expectante. Após 55 meses, a paciente refere mastalgia acíclica moderada e mantém seguimento clínico no Serviço

Pure and Mixed Tubular Carcinoma of the Breast: Mammographic and Sonographic Differential Features

OBJECTIVE: We wanted to evaluate the mammographic and sonographic differential features between pure (PT) and mixed tubular carcinoma (MT) of the breast. MATERIALS AND METHODS: Between January 1998 and May 2004, 17 PTs and 14 MTs were pathologically confirmed at our institution. The preoperative mammography (n = 26) and sonography (n = 28) were analyzed by three radiologists according to BI-RADS. RESULTS: On mammography, a mass was not detected in eight patients with PT and in one patient with MT (57% vs. 8%, respectively, p = 0.021), which was statistically different. The other findings on mammography and sonography showed no statistical differences between the PT and MT, although the numerical values were different. When the lesions were detected mammographically, an irregularly shaped mass with a spiculated margin was more frequently found in the MT than in the PT (100% vs. 83%, respectively, p = 0.353). On sonography, all 28 patients presented with a mass and most lesions showed as not being circumscribed, hypoechoic masses with an echogenic halo. Surrounding tissue changes and posterior shadowing were more frequently found in the MT than in the PT (75% vs. 50%, respectively, p = 0.253, 58% vs. 19%, respectively, p = 1.000). An oval shaped mass was more frequently found in the PT than in the MT (44% vs. 25%, respectively; p = 0.434). CONCLUSION: PT and MT cannot be precisely differentiated on mammography and sonography. However, the absence of a mass on mammography or the presence of an oval shaped mass would favor the diagnosis of PT. An irregularly shaped mass with surrounding tissue change and posterior shadowing on sonography would favor the diagnosis of MT and also a less favorable prognosis.

Multiple Myeloma of the Male Breast: A Case Report

Breast involvement of multiple myeloma is very rare, expecially in men. We describe the mammographic and sonographic findings of multiple myeloma involving the male breast.

Atypical Ductal Hyperplasia of the Breast: Radiologic and Histopathologic Correlation

PURPOSE: To evaluate the clinical and radiologic findings of atypical ductal hyperplasia (ADH) using mammography and ultrasonography, and to correlate the radiologic and histopathologic findings. MATERIALS AND METHODS: Sixty-four pathologically proven lesions in 64 patients who were examined between March 2000 and March 2003 were the subject of this study. Mammography was performed in all 64 cases, and ultrasonography in 30. Two radiologists retrospectively evaluated the radiologic findings, classifying them as one of four types: mass, microcalcification, other finding, and no detected lesion. At mammography, masses were classified according to their shape, margin, and density and microcalcifications according to their shape and distribution. At ultrasonography, masses were evaluated in terms of their shape, margin, internal and posterior echotexture, ductal extension, and parallelism to skin. Geographic correlation between the radiologic and histopathologic findings was classified as direct, near direct, or remote correlation. RESULTS: Mammography demonstrated 37 cases of microcalcification (57.8%), 14 in which masses were present (21.9%), two in which there were other findings (3.1%), and 11 in which lesions were not detected (17.2%). The "other finding" was ductectasia. Microcalcifications were round in 19 cases, pleomorphic heterogeneous in 16, and branching linear in one. The most common distribution of microcalcification was clustered (29 cases; 78.4%). Masses were oval or round in nine cases and irregular in three, and in seven cases their margin was ill-defined. In 13 cases, the density of the masses was equal to that of breast tissue. Ultrasonography showed that the masses were round or oval in 15 cases and irregular in 14, and that the margin was ill-defined in 16 cases and circumscribed in ten. In 19 cases, the echotexture of the masses was low, and in 20 cases, heterogeneous. Parallel orientation was seen in 25 cases, and ductal extension in 22. Category 4 was the most common final assessed BI-RADS category, found in 75% of cases. Radiologic-histopathologic correlation was direct in 44 cases, near direct in 13, and remote in seven. Clinically, self or clinical examination of the breast revealed no abnormality in 47 cases, a palpable mass in seven, nipple discharge in seven, and breast pain in three. CONCLUSION: At mammography, the most common finding of ADH was clustered round or pleomorphic heterogeneous microcalcifications, and at ultrasonography, illdefined, round or oval, or irregular-shaped, hypoechoic masses with parallel orientation and ductal extension. Clinically, most ADH was incidentally discovered at radiologic examination. In this study, 17.2% of ADH cases were not demonstrated by mammography but were detected at ultrasonography, and for the detection of ADH, the use of this latter modality, alongside mammography, is thus feasible.