Spiculated Masses

A spiculated mass is a centrally dense lesion seen on mammography with sharp lines radiating from its margin. The spicules can vary greatly in length, from a few millimeters to several centimeters. In malignant lesions, spicules represent a mixture of tumor cells and fibrosis invading the normal tissue surrounding the lesion. Although a spiculated mass is thought of as a classic finding of malignancy on mammography, ultrasound, and MRI, its differential diagnosis includes benign lesions. However, unless clinical history strongly supports a benign diagnosis, a spiculated mass on any modality typically will require additional workup and biopsy. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, radiology–pathology correlations, and clinical management recommendations for a spiculated mass. Topics discussed include both malignant and benign masses.

Imaging Review of Skeletal Tumors of the Pelvis Malignant Tumors and Tumor Mimics

The Scientific World JOURNAL ◽

10.1100/2012/240281 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 4

Author(s):

Gandikota Girish ◽

Karen Finlay ◽

David Fessell ◽

Deepa Pai ◽

Qian Dong ◽

...

Keyword(s):

Differential Diagnosis ◽

Malignant Tumors ◽

Clinical History ◽

Imaging Features ◽

Resonance Imaging ◽

Benign Lesions ◽

Plain Films ◽

Malignant Lesions ◽

Pelvic Lesions

Malignant lesions of the pelvis are not uncommon and need to be differentiated from benign lesions and tumor mimics. Appearances are sometimes nonspecific leading to consideration of a broad differential diagnosis. Clinical history, anatomic location, and imaging characterization can help narrow the differential diagnosis. The focus of this paper is to demonstrate the imaging features and the role of plain films, computed tomography, and magnetic resonance imaging for detecting and characterizing malignant osseous pelvic lesions and their common mimics.

One-View Asymmetry

10.1093/med/9780190270261.003.0013 ◽

2018 ◽

Author(s):

Paul H. Levesque ◽

Laura Sheiman

Keyword(s):

Differential Diagnosis ◽

Clinical Features ◽

Normal Tissue ◽

Mirror Image ◽

Imaging Features ◽

Benign Lesions ◽

Tissue Density ◽

Diagnosis And Management ◽

Fibroglandular Tissue ◽

Ultrasound Assessment

This chapter, appearing in the section “Asymmetry, Mass, and Distortion,” will discuss the presence of tissue asymmetry visualized only on one view. The distribution of fibroglandular tissue is extremely variable and unique from one patient to another; however, in most patients the parenchyma is usually distributed within the breasts symmetrically in a “mirror-image” fashion. Areas of tissue density (asymmetry) may be seen that are only visualized on the craniocaudal (CC) or mediolateral oblique (MLO) view. In the majority of patients, this finding represents superimposed normal tissue, or islands of normal parenchyma. Occasionally, underlying benign lesions may present as a tissue asymmetry. Rarely, a one-view asymmetry may represent a malignancy. This section will discuss the imaging features (including mammography, tomosynthesis, and ultrasound assessment), clinical features, differential diagnosis, and management suggestions for one-view asymmetries.

Non-Mass Enhancement on MRI

10.1093/med/9780190270261.003.0031 ◽

2018 ◽

Author(s):

Diana L. Lam ◽

Habib Rahbar

Keyword(s):

Breast Cancer ◽

Clinical Features ◽

Morphological Features ◽

Post Contrast ◽

Imaging Protocols ◽

Background Parenchymal Enhancement ◽

Normal Background ◽

Mass Enhancement ◽

Parenchymal Enhancement

Breast cancer presents on MRI as an enhancing finding on post-contrast T1-weighted images that is distinct from normal background parenchymal enhancement (BPE), and these enhancing lesions can be further described as a focus, mass, or non-mass enhancement (NME). Each enhancing lesion, with the exception of a focus, can be described further with specific morphological features that are defined by the ACR BI-RADS Atlas. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations of a focus of enhancement and non-mass enhancement on MRI. Topics discussed include distinguishing a focus from normal BPE, benign versus suspicious features of a focus, NME characterization, and kinetic enhancement curves.

Enhancing Mass on MRI

10.1093/med/9780190270261.003.0032 ◽

2018 ◽

Author(s):

John R. Scheel ◽

Diana L. Lam

Keyword(s):

Clinical Features ◽

Irregular Shape ◽

Differential Diagnoses ◽

Imaging Protocols ◽

Enhancement Curve ◽

Rim Enhancement ◽

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.

Multiple Circumscribed Masses

10.1093/med/9780190270261.003.0019 ◽

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 ◽

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.

Amorphous/Indistinct Calcifications (Regional/Diffuse)

10.1093/med/9780190270261.003.0040 ◽

2018 ◽

Author(s):

Lilian Wang

Keyword(s):

Breast Cancer ◽

Differential Diagnosis ◽

Morphological Classification ◽

Imaging Protocols ◽

Fibrocystic Change ◽

Perimenopausal Women ◽

Risk Of Malignancy ◽

Sclerosing Adenosis ◽

Diffuse Distribution

Amorphous calcifications are calcifications that are sufficiently small and/or hazy that a more specific morphological classification cannot be made. Historically, such calcifications were referred to as “indistinct” calcifications. The likelihood of malignancy and the management of amorphous calcifications largely depend on their distribution. The majority of amorphous calcifications are benign, most often due to fibrocystic change (60%). Sclerosing adenosis commonly occurs in perimenopausal women and is associated with a 1.5–2.1x relative risk for development of breast cancer. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis, and management recommendations for amorphous/indistinct calcifications in a regional or diffuse distribution. Topics discussed include influence of distribution on risk of malignancy and pathological entities, including sclerosing adenosis.

Mass with Indistinct Margins

10.1093/med/9780190270261.003.0024 ◽

2018 ◽

Author(s):

Lonie R. Salkowski

Keyword(s):

Clinical Features ◽

Differential Diagnoses ◽

Imaging Protocols ◽

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

10.1093/med/9780190270261.003.0044 ◽

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 ◽

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

10.1093/med/9780190270261.003.0033 ◽

2018 ◽

Author(s):

Anna I. Holbrook

Keyword(s):

Clinical Features ◽

Radiation Treatment ◽

Differential Diagnoses ◽

Architectural Distortion ◽

Fat Necrosis ◽

Surgical Clips ◽

Imaging Protocols ◽

Skin Retraction ◽

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

10.1093/med/9780190270261.003.0045 ◽

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 ◽

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.