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.

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.

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.

Lymphadenopathy

2018 ◽  
Author(s):  
Matthew A. Stein
Keyword(s):  
Lymph Nodes ◽  
Histological Evaluation ◽  
Imaging Features ◽  
Malignant Cells ◽  
Lymphatic Function ◽  
Nodal Basin ◽  
Anatomy And Physiology ◽  
Imaging Protocols ◽  
Abnormal State ◽  
Management Recommendations

Lymphadenopathy is a pathological or abnormal state of one or more lymph nodes in a nodal basin that occurs in response to pathogens, immunogens, or malignant cells that are detected within the lymph. Malignant lymphadenopathy may be detected by physical exam and/or imaging findings, but it is ultimately confirmed or excluded by histological evaluation. This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations of lymphadenopathy detected by mammography, tomosynthesis, and ultrasound (US). Topics include the anatomy and physiology of breast lymphatic function, the anatomy and imaging features of lymph nodes, differential diagnosis of lymphadenopathy, and the imaging assessment of the axillary nodal basin in the context of known breast cancer.

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.

Pleomorphic Calcifications

2018 ◽  
Author(s):  
Stephanie A. Lee-Felker ◽  
Colin J. Wells
Keyword(s):  
Needle Biopsy ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Calcium Deposition ◽  
Imaging Features ◽  
Triangular Shape ◽  
Imaging Protocols ◽  
Multifocal Breast Cancer ◽  
Management Recommendations

Pleomorphic calcifications are categorized among calcifications with suspicious morphology: amorphous, coarse heterogeneous, fine linear or fine-linear branching, and fine pleomorphic calcifications. Unlike amorphous calcifications, pleomorphic calcifications are more conspicuous, with discernible shapes that appear predominantly irregular, and are variable in size and configuration. A segmental distribution, seen as a triangular shape with its apex centered at the nipple, is especially suspicious for ductal carcinoma in situ (DCIS) or multifocal breast cancer, as its pattern of calcium deposition suggests involvement of a duct system within the breast. This chapter, appearing in the section on calcifications, reviews the key clinical and imaging features, imaging protocols, differential diagnoses, and management recommendations for pleomorphic calcifications. Topics discussed include characteristic morphology and distribution of pleomorphic calcifications, BI-RADS assessments, core needle biopsy, and radiological–pathological correlation.

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.

Breast Implants

2018 ◽  
Author(s):  
Nanette D. DeBruhl ◽  
Nazanin Yaghmai
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Features ◽  
Breast Implants ◽  
Screening Mammography ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Imaging Protocols ◽  
Age Appropriate ◽  
Management Recommendations

The presence of breast implants limits the amount of tissue that can be visualized on mammography and tomosynthesis. The proper mammographic positioning of the breasts of women with implants requires special training. More tissue can be visualized in women with sub-pectoral implants than in women with sub-glandular implants. Women with implants are recommended to have age-appropriate routine interval screening mammography for detection of cancer. If an implant rupture is suspected, ultrasound and MRI are used as adjunct imaging modalities. This chapter, appearing in the section on breast implants, reviews the key imaging and clinical features, imaging protocols and pitfalls, and management recommendations for breast implants. Topics discussed include types of implants, imaging findings of intact implants, and signs of ruptured implants, using mammography, ultrasound, and magnetic resonance imaging.

Invasive Mammary Paget Disease Without an Underlying Breast Cancer: A Case Report

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S43-S44 ◽  
Author(s):  
Alexis Bousamra ◽  
Nazia Khatoon ◽  
Ariel Sandhu ◽  
Jan Silverman ◽  
Mary Beth Malay
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Ductal Carcinoma ◽  
Malignant Lesion ◽  
Sentinel Lymph Nodes ◽  
Fish Analysis ◽  
Nipple Areolar Complex ◽  
Paget Disease ◽  
Areolar Complex ◽  
Skin Punch Biopsy

Abstract Mammary Paget disease (MPD) is a malignant lesion of the nipple-areolar complex and considered an intraepidermal sign of an underlying invasive or in situ carcinoma. In rare instances, mammary Paget cells can invade the dermis. Comprehensive literature review identified 33 such cases. Here, we report a case of a 48-year-old female with invasive MPD, without an associated underlying breast cancer. Only five such presentations are reported. With a presentation of right nipple-areolar excoriation for 2 years, skin punch biopsy was performed and reported as “Paget disease.” Further evaluation with bilateral mammograms failed to show any primary mass or calcifications. Bilateral breast MRI revealed focal nonmass enhancement in upper outer quadrant in both breast, the biopsy of which showed benign breast tissue. Right breast nipple areolar complex resection demonstrated MPD extensively involving the epidermis. Multiple foci of invasive ductal carcinoma are present, growing downward into the nipple dermis, the largest focus being 0.2 cm in greatest dimension. No lymphovascular invasion is identified. The mammary Paget cells are positive for Cam 5.2 and epithelial membrane antigen (EMA) and negative for keratins 7 and 20. The invasive tumor cells are strongly positive for estrogen receptor (100%) and progesterone receptor (75%) and equivocal (2+) for Her2/Neu. FISH analysis showed amplification for HER2 (HER2/CEP17 ratio: 2.75). Four right axillary sentinel lymph nodes are negative for carcinoma. Two of the five patients with invasive MPD described in the literature, and without underlying breast cancer, had a sentinel lymph node biopsy performed. Isolated tumor clusters were present in one of these two cases. In summary, we describe a rare case of invasive MPD without an underlying breast cancer. Although sentinel lymph nodes are important to assess metastasis, further cases are required to evaluate the significance and prognosis of this rare entity.

Non-Mass Enhancement on MRI

2018 ◽  
Author(s):  
Diana L. Lam ◽  
Habib Rahbar
Keyword(s):  
Breast Cancer ◽  
Clinical Features ◽  
Morphological Features ◽  
Post Contrast ◽  
Imaging Protocols ◽  
Background Parenchymal Enhancement ◽  
Management Recommendations ◽  
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.

Secretory Calcifications

2018 ◽  
Author(s):  
Christopher P. Ho
Keyword(s):  
Carcinoma In Situ ◽  
Plasma Cells ◽  
Ductal Carcinoma ◽  
Close Association ◽  
Epithelial Hyperplasia ◽  
Appropriate Use ◽  
Imaging Protocols ◽  
Management Recommendations

Secretory calcifications are large rod-like calcifications that are often seen in a linear or segmental distribution. They can often be easily differentiated from more malignant-appearing calcifications because they are smooth and much coarser than calcifications seen with ductal carcinoma in situ (DCIS). Secretory calcifications are thought to be associated with duct ectasia and have been historically referred to as “plasma cell mastitis” because of the close association of plasma cells within the ductal infiltrates and epithelial hyperplasia. 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 secretory calcifications. Topics discussed include appropriate use of magnification views, how to differentiate the calcifications from more suspicious ones, and appropriate follow-up.

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