Multiple Circumscribed Masses

2018 ◽  
Author(s):  
Erin L. Prince ◽  
Heidi R. Umphrey
Keyword(s):  
Lymph Nodes ◽  
Clinical Features ◽  
Clinical Information ◽  
Differential Diagnoses ◽  
Surrounding Tissue ◽  
Imaging Protocols ◽  
Screening Mammograms ◽  
Management Recommendations

A circumscribed mass is a mass with margins demonstrating a sharp demarcation between the lesion and surrounding tissue. On mammography, at least 75% of the margin must be well defined in order for the mass to qualify as circumscribed. Multiple circumscribed masses may be seen unilaterally or bilaterally and can be seen on up to 1.7% of screening mammograms. After mammography, these masses may need to be further evaluated with ultrasound and correlated with clinical information. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for multiple circumscribed masses. Topics discussed include cysts, fibroadenomas, oil cysts, metastases, lymph nodes, and neurofibromas.

Duct Ectasia

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Lymph Nodes ◽  
Chronic Inflammation ◽  
Clinical Features ◽  
Nipple Discharge ◽  
Screening Mammography ◽  
Differential Diagnoses ◽  
Sonographic Evaluation ◽  
Imaging Protocols ◽  
Management Recommendations

Duct ectasia is a term used to describe benign dilation of fluid-filled mammary ducts. Duct ectasia is characterized by tubular fluid-filled structures >2 mm in diameter that are commonly bilateral and subareolar in location. Ductal dilation is due to weakened wall elasticity that occurs with age. The ducts fill with secretions that may result in intermittent nipple discharge or chronic inflammation. When duct ectasia involves multiple ducts bilaterally, it can be dismissed on screening mammography; however, a solitary dilated duct should be further evaluated, given the potential for associated non-calcified DCIS. This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for duct ectasia. Topics discussed include solitary dilated duct, nipple discharge, and sonographic evaluation of ducts.

Multiple Irregular Masses

2018 ◽  
Author(s):  
Erin L. Prince ◽  
Heidi R. Umphrey
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Features ◽  
Clinical Information ◽  
Differential Diagnoses ◽  
Granulomatous Mastitis ◽  
Resonance Imaging ◽  
Imaging Protocols ◽  
Synchronous Cancers ◽  
Management Recommendations

Irregular masses seen on two-view mammography are defined as masses with margins that are neither round nor oval. They may demonstrate indistinct, microlobulated, obscured, or spiculated margins and have a variety of densities, ranging from high to low or fat density. Irregular masses tend to imply a more suspicious finding. Multiple irregular masses may be seen unilaterally or bilaterally, and are usually further evaluated with either ultrasound or magnetic resonance imaging and correlated with clinical information. The etiology of multiple irregular masses is vast. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for multiple irregular masses. Topics discussed include metastases, granulomatous mastitis, diabetic mastopathy, and second synchronous cancers.

Intracystic/Intraductal Mass

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Lymph Nodes ◽  
Papillary Carcinoma ◽  
Clinical Features ◽  
Nipple Discharge ◽  
Differential Diagnoses ◽  
Imaging Findings ◽  
Solid Mass ◽  
Common Cause ◽  
Imaging Protocols ◽  
Management Recommendations

This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for intracystic and intraductal masses. The differential diagnoses of intraductal and intracystic masses are similar, with papilloma the most common cause for both. Therefore, we review descriptive terms for both together, with similar implications and management recommendations. Intracystic masses have a higher association with malignancy than intraductal masses, due in part to overlap of imaging appearances of intracystic mass and complex cystic and solid mass. Topics discussed include intraductal and intracystic masses, evaluation of ducts, papilloma, papillary carcinoma and nipple discharge.

Enhancing Mass on MRI

2018 ◽  
Author(s):  
John R. Scheel ◽  
Diana L. Lam
Keyword(s):  
Clinical Features ◽  
Irregular Shape ◽  
Differential Diagnoses ◽  
Imaging Protocols ◽  
Enhancement Curve ◽  
Rim Enhancement ◽  
Management Recommendations ◽  
Space Occupying Lesion

The ACR BI-RADS Atlas defines a “mass” on MRI as a space-occupying lesion with convex borders. Masses are characterized by their morphology and their internal enhancement characteristics. Mass morphology descriptor categories include shape (oval, round, irregular), margins (circumscribed, irregular, spiculated), and internal enhancement (homogeneous, heterogeneous, rim enhancement, dark internal septations). Suspicious morphology descriptors of MRI masses include irregular shape, irregular or spiculated margins, and heterogeneous internal enhancement. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for an enhancing mass on MRI. Topics discussed include characteristics of benign and malignant masses, classic benign masses, and enhancement curve assessment.

Mass with Indistinct Margins

2018 ◽  
Author(s):  
Lonie R. Salkowski
Keyword(s):  
Clinical Features ◽  
Differential Diagnoses ◽  
Imaging Protocols ◽  
Management Recommendations ◽  
Entire Margin

Masses described as having indistinct margins lack a clear demarcation of a portion or the entire margin from the surrounding tissues. The indistinctness of the margin raises the possibility of infiltration; therefore, this descriptor implies suspicion for malignancy. “Indistinct” differs from “obscured.” A mass with obscured margins insinuates that the surrounding tissues masks or covers the presence of the lesion. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for masses with indistinct margins. Topics discussed include differentiation of the mass with indistinct margins from an obscured mass and focal asymmetry, and how the presence of adjacent features can increase the suspicion of the mass with indistinct margins.

Nipple Discharge

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Lymph Nodes ◽  
Clinical Features ◽  
Nipple Discharge ◽  
Fluid Secretion ◽  
Clinical Implications ◽  
Imaging Findings ◽  
Fluid Content ◽  
Sonographic Evaluation ◽  
Imaging Protocols ◽  
Management Recommendations

Nipple discharge refers to expressible or spontaneous drainage of fluid from one or more duct orifices of the nipple. Discharge indicates excess fluid secretion into one or more ducts that will drain through an unobstructed duct orifice onto the nipple skin. The fluid content and appearance are important as they have clinical implications. Nipple discharge that is clear or bloody, unilateral (typically uniductal) and spontaneous (fluid discharges without breast or nipple compression) is considered suspicious for malignancy, though most cases are due to benign papillomas. This chapter, appearing in the section on nipple, skin and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple discharge. Topics discussed include clinical evaluation of nipple discharge, sonographic evaluation of ducts and nipple, ductography, intraductal mass, and papilloma.

Dystrophic Calcifications

2018 ◽  
Author(s):  
Anna I. Holbrook
Keyword(s):  
Clinical Features ◽  
Radiation Treatment ◽  
Differential Diagnoses ◽  
Architectural Distortion ◽  
Fat Necrosis ◽  
Surgical Clips ◽  
Imaging Protocols ◽  
Skin Retraction ◽  
Management Recommendations

Dystrophic calcifications are typically large (usually >1 mm), coarse, irregular or plaque-like and associated with lucent centers. They also may be thin, smooth, and round or oval, with lucent centers, called “rim” (previously also known as “eggshell”) calcifications. They form in response to trauma, including surgery or irradiation. They can be seen in association with other findings of breast trauma, including surgical clips, architectural distortion, skin retraction, skin thickening, oil cysts, or trabecular thickening. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for dystrophic calcifications. Topics discussed include findings after breast trauma or surgery/radiation treatment and the evolution of fat necrosis.

Nipple Abnormalities

2018 ◽  
Author(s):  
Nicole S. Winkler
Keyword(s):  
Inflammatory Response ◽  
Lymph Nodes ◽  
Clinical Features ◽  
Ductal Carcinoma ◽  
Imaging Features ◽  
Malignant Cells ◽  
Imaging Findings ◽  
Paget Disease ◽  
Imaging Protocols ◽  
Management Recommendations

New nipple retraction and new nipple inversion can be secondary to malignancy, post-surgical change, inflammation, or infection. Paget disease of the nipple is characterized by an inflammatory response of the nipple epidermis to malignant cells extending from ductal carcinoma in the lactiferous sinus. A mass arising within the nipple is rare and usually a variant of a papilloma arising in the nipple (nipple adenoma). This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple retraction. Topics discussed include imaging features of nipple retraction, both benign and malignant causes of nipple retraction, Paget disease of the nipple, and masses occurring in the nipple.

Milk of Calcium

2018 ◽  
Author(s):  
Christopher P. Ho
Keyword(s):  
Calcium Oxalate ◽  
Clinical Features ◽  
Initial Evaluation ◽  
Differential Diagnoses ◽  
Calcium Oxalate Crystals ◽  
Appropriate Use ◽  
Milk Of Calcium ◽  
Imaging Protocols ◽  
Management Recommendations

Milk of calcium (MOC) is simply calcium oxalate crystals precipitated within the microcysts (acini) of the breast lobules. MOC has a very distinct mammographic appearance. It is a benign entity, and when seen and properly identified, it requires no further workup or follow-up. It is, however, important to recognize the proper initial evaluation of MOC so as to avoid misdiagnosis or potential unnecessary biopsies.This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for milk of calcium. Topics discussed include appropriate use of magnification views, hints to recognize the distinct appearance of milk of calcium, and management.

Coarse Heterogeneous Calcifications

2018 ◽  
Author(s):  
Cheryce Poon Fischer
Keyword(s):  
Breast Cancer ◽  
Clinical Features ◽  
Differential Diagnoses ◽  
Intermediate Risk ◽  
Imaging Protocols ◽  
Prior Surgery ◽  
Management Recommendations

Coarse heterogeneous calcifications are irregular calcifications that are between 0.5 mm and 1 mm in size. They are usually in a group and are smaller in size than dystrophic calcifications. Although they are of intermediate risk for breast cancer (most commonly, DCIS), they are also associated with benign entities, such as hyalinized/degenerating fibroadenoma, areas of fibrosis, papilloma, and evolving dystrophic calcifications from prior surgery or trauma. Generally, numerous bilateral groups of coarse heterogeneous calcifications may be considered benign. However, baseline magnification views may be helpful to confirm the morphology of the calcifications and to exclude more suspicious pleomorphic morphology. Coarse heterogeneous calcifications in a linear or segmental distribution are suspicious. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for coarse heterogeneous calcifications.

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