Giant breast masses: a pictorial essay

WHY THE STUDY WAS PERFORMED:

This pictorial essay discusses the imaging and pathological findings of a range of giant breast lesions. Some lesions demonstrate characteristic mammographic appearances. These include lipomas and hamartomas. Other lesions may be mammographically indistinguishable, such as simple cysts and some malignant breast carcinomas. Ultrasound may help further characterisation through the demonstration of a range of ultrasound specific characteristics such as posterior enhancement, internal septation and increased vascularity. This information increases the likelihood of diagnostic accuracy and may guide clinical management.

WHAT THE PAPER COVERS:

The paper reviewed the pathophysiology and epidemiology as well as the mammographic and ultrasound appearances of giant fibroadenomas, phyllodes tumours, lipomas, hamartomas, cystic lesions, breast abscesses, breast hamartomas and breast carcinomas.

Giant fibroadenomas are common benign masses that are classified as ‘giant’ at diameters >5-10cm. They appear as well-circumscribed masses with similar echogenicity to the surrounding breast tissue on a mammogram. Under ultrasound, fibroadenomas are homogenous rounded masses, hypo- to iso-echoic and often demonstrate vascularity.

Phyllodes tumours are rare lesions that appear similar to fibroadenomas on mammogram. Ultrasound may present with a variety of appearances making further imaging or histopathological investigation necessary in the diagnosis of a phyllodes tumour.

Lipomas are benign encapsulated lesions that may not be well seen on mammogram. Sonographically, they are well-circumscribed lesions with no posterior enhancement, minimal or no vascularity and may demonstrate variable echogenicity.

Hamartomas demonstrate a characteristic well-circumscribed encapsulated lesion on mammogram. Conversely, the ultrasound appearance is variable limiting its use as a diagnostic tool.

Cystic lesions may be simple, complicated or complex and so present with a variety of appearances. On mammogram, cysts are round, well-defined lesions. Ultrasound appearance may vary from anechoic and well-defined with posterior acoustic enhancement to a mass with solid components, septations, thick walls, vascularity, debris and/or a lack of posterior acoustic enhancement.

Breast abscess is often a complication of mastitis. Ultrasound may demonstrate size, depth and number of septations. Mammogram may be used as a tool to demonstrate malignancy in atypical presentations and also to monitor resolution.

Breast haematomas often occur in the setting of trauma. Mammogram demonstrates asymmetrical densities or well-circumscribed dense nodules with associated peripheral oedema. The appearance of a haematoma changes under ultrasound with age of the lesions from hyperechoic in the early stages to hypoechoic in later stages.

Breast carcinoma is seen as a soft tissue mass on mammogram that may include spiculation

REVIEWED BY Gina Humphries ASA SIG Women’s Health

REFERENCE Chitty C, Dessauvagie B, Taylor D. Giant breast masses: a pictorial essay. J Med Imaging Radiat Oncol. 2019;63:467–72

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Giant breast masses: a pictorial essay continued

and microcalcifications. Under ultrasound, breast carcinoma may show an irregular, ill-defined and hypoechoic mass. Spiculations, calcification and posterior acoustic shadowing may also be seen.

HOW THE PAPER WAS WRITTEN:

A comprehensive review of giant breast masses was performed by Chitty, Dessauvagie and Taylor.

RELEVANCE TO CLINICAL PRACTICE:

Providing concise but comprehensive information on the mammographic appearance and ultrasound appearance of a range of giant breast masses may allow the sonographer to confidently apply this information in a clinical setting. This may further diagnostic assessment and understanding of lesions encountered in daily practice. Providing appropriate imaging to the clinician can help differentiate benign from malignant breast lesions which in turn may guide appropriate management of the patient. n