Non mass-like enhancement categories detected by breast MRI and histological findings.

OBJECTIVE: To correlate the different non masslike enhancement categories detected by Magnetic Resonance Imaging (MRI) and the corresponding histological findings. PATIENTS AND METHODS: Two experienced radiologists reviewed the MRI examinations of 94 patients presenting non mass-like enhancements who had performed histological evaluation. According to the BI-RADS (Breast Imaging Reporting and Data System) lexicon, non masslike enhancements were classified as focal, linear, segmental, regional, ductal and diffuse enhancements. We focused on segmental, regional and ductal patterns. RESULTS: Among the 94 patients, 52.1% showed a regional pattern, 27.7% a segmental pattern and 20.2% a ductal pattern of enhancement. Of the 49 patients showing a regional pattern, the histological diagnosis was ductal invasive carcinoma (DIC) in 28 cases, ductal carcinoma in situ (DCIS) in 4 cases, lobular invasive carcinoma (LIC) in 3 cases and a benign disease in 9 cases. Of the 26 patients showing a segmental pattern, the histological outcome was DIC in 10 cases, DCIS in 7 cases and a benign disease in 5 cases. Among the 19 patients showing a ductal pattern, the result was DIC in 4 cases, DCIS in 4 cases and a benign disease in 7 cases. In most cases DIC presented as a regional pattern, while DCIS showed a segmental pattern in 26.9%, a ductal pattern in 21.1% and a regional pattern in 8.2% of cases. CONCLUSIONS: Our findings about ductal and segmental enhancements agree with the literature. We found a high rate of DIC presenting as a regional enhancement, instead; thus, we recommend a more detailed diagnosis, especially when an homogeneous/heterogeneous and clumped internal enhancement pattern is present.

Neuroendocrine lung cancer presenting as a breast lump.

We report the case of a 54-year-old woman presenting to our attention for a palpable breast lump. The mammographic examination showed multiple round/oval areas of increased opacity spread on both breasts. The ultrasonographic examination showed multiple hypo-anechoic nodularities without retro-tumor acoustic shadowing. The mammo/ultrasonographic findings were worthy of histological analysis, thus we performed a ultrasound (US)-guided core-biopsy, obtaining a histological diagnosis of neuroendocrine carcinoma, probably originating from the lungs. The subsequent whole body CT scan, performed to search the primary neoplasm, put in evidence a neoplasm in the left lung, involving the pulmonary hilum, and infiltrating the bronchial branches. Moreover, there were multiple secondary lesions involving adrenal glands, brain and bowel. A review of the literature confirmed that breast lumps may be the first manifestation of a metastatic disease.

An incidental finding of breast cancer after breast injury.

We report of a 52-year-old woman presenting with a breast palpable mass after a trauma due to accidental fall. The patient came to our attention to perform an ultrasonographic examination because of the persistence of the mass after the trauma. The exam showed an hypo-anechoic oval formation with blurred margins and no vascularization at Power Doppler, located to the union of the upper quadrants of the right breast. The patient also performed mammographic examination, which showed an unknown oval radiopaque area. The findings were consistent with post-traumatic hematoma, even in relation to the anamnestic data, therefore we recommended anti-inflammatory therapy and a new check in fifteen days. The next ultrasonographic examination showed the persistence of the mass, slightly reduced in size, so we tried to achieve a more detailed diagnosis by performing MRI; however, the diagnostic doubt still remained, so we decided to perform a US-guided core-biopsy: the histological diagnosis was infiltrating ductal carcinoma of the breast. A review of the literature confirmed that breast lesions often are incidental findings after a breast trauma.

Skin thickening as unique pathologic sign of an inflammatory breast cancer: a case report and review of the literature.

We report the case of a 42-year-old woman with inflammatory cancer of the right breast treated with neoadjuvant chemotherapy, surgery, additional chemotherapy, and consolidative radiotherapy (RT), that has metastatized to the chest wall and presented a resumption of disease on the contralateral breast. Magnetic Resonance (MR), performed after the second phase's fourth round of additional chemotherapy, showed a modest reduction of scar metastases on the right and a contralateral anomalous skin thickening with high signal intensity in T2 weighted images (WI) with multiple mass-like enhancements located in a wide area of the central region at the union of higher quadrants. These findings were suggestive for resumption of contralateral disease; the biopsy confirmed an inflammatory breast cancer (IBC) infiltrating lobular type with high mitotic rate. A retrospective evaluation of the previous MR exam, performed 5 months before, was conducted: on the left side only a modest skin thickening was found as an early sign. A careful review of the literature has confirmed that skin thickening, increased density and clinical signs of inflammation are the most common findings in inflammatory cancer. We report the case of a patient affected by IBC whose unique early sign of resumption on the contralateral breast was skin thickening.