DiDomenico P & Middleton W. Sonographic Evaluation of Palpable Superficial Masses. Although it can coexist with malignant lesions [49, 50], PASH itself is a benign entity without an increased risk for malignancy [51]. In 5-15% of patients, lipomas are multiple, and ~33% of these will be familial 5. The mass remained stable sonographically for 30months and mammographically for 9years. Patients with a clinical presentation typical of a breast abscess require a short-term, 7- to 14-day follow-up after treatment with antibiotics and drainage [2]. The focal asymmetry had developed since her prior available mammogram performed 4years earlier (c). This condition can manifest as a palpable mass or be clinically occult. 2004;233(3):763-7. Bilateral mediolateral oblique mammogram (a) show diffuse skin thickening (solid arrow), global asymmetry, and trabecular thickening (dashed arrows) in the left breast, asymmetric from the right breast. Patients typically present in adulthood (5th-7thdecades). If the entering or exiting nerve is eccentric to the mass, schwannoma may be suggested, whereas in neurofibroma the nerve tends to be central. The application of. Needle biopsy showed acute inflammatory cells consistent with abscess without evidence of malignancy. 2002;224(1):99-104. This process results in a localized area of fibrous tissue associated with hypoplastic mammary ducts and lobules. Soft tissue and bone tumours. Liver metastases are by far the most common hepatic malignancy, with many of the most common primaries readily seeding to the liver. When reporting lipomas on MRI, the article lipoma vs well-differentiated liposarcomacovers the differentiating factors well. Musculoskeletal Imaging Cases. Core needle biopsy revealed benign breast tissue with lymphoplasmacytic infiltrate. Breast J 14(1):106, Nakazono T, Satoh T, Hamamoto T, Kudo S (2003) Dynamic MRI of fibromatosis of the breast. 3). Ultrasound of adenomatoid tumors reveals an isoechoic mass with increased vascularity (Fig. The management of sclerosing adenosis ultimately relies once again on the imaging features. 2014;52(6):1295-305. T1-weighted non-fat-suppressed (c) and T1-weighted fat-suppressed (d) post-contrast MRI images show a well-circumscribed, heterogeneously enhancing breast mass suspicious for a sarcoma (arrow). 9. Mammographically, PASH usually presents as an oval or round, noncalcified mass with circumscribed margins ranging from 0.3 to 11cm (Fig. Use pressure to distinguish fluid (which is compressible and can be displaced) from solid tissue. Radiol Case Rep 10(2):1116, Scaranelo A, Bukhanov K, Crystal P, Mulligan AM, Omalley FP, (2007) Granular cell tumour of the breast: MRI findings and review of the literature. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Ann Oncol 28(10):23992408, Duazo-Cassin L, Le Guellec S, Lusque A et al (2019) Breast desmoid tumor management in France: toward a new strategy. Superficial fibromatosis includes plantar and palmar fibromas. Multiple nodules on the plantar fascia are diagnostic of plantar fibromatosis. Liposarcoma is the second most common soft tissue sarcoma, accounting for up to 35% of soft tissue sarcomas. Granulomatous mastitis typically presents as a firm palpable mass that is sometimes associated with skin erythema or pain [11]. Its superficial topography may be suggestive of the diagnosis, but biopsy is often performed due to its non-specific presentation. Check for errors and try again. Benign lipomas are circumscribed soft masses, usually encapsulated, and composed almost entirely of fat. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. more echogenicity than fat or equal to fibroglandular tissue; https://doi.org/10.1186/s13244-021-00991-x, DOI: https://doi.org/10.1186/s13244-021-00991-x. Ann Surg Oncol 16(9):25872593, Bonvalot S, Terns N, Fiore M et al (2013) Spontaneous regression of primary abdominal wall desmoid tumors: more common than previously thought. Dr. David Sneid answered Endocrinology 43 years experience Probably benign: Depends on the appearance on ultrasound and also on lab and clinical parameters. Breast ultrasonography (US) is recognized as a useful diagnostic tool for palpable or nonpalpable breast masses, but isoechoic lesions surrounded by fat can be a challenge for radiologists and can result in false-negative interpretations and a delayed diagnosis of breast cancer. Superficial soft-tissue masses can generally be categorized as mesenchymal tumors, skin appendage lesions, metastatic tumors, other tumors and tumorlike lesions, or inflammatory lesions. 12ac). MRI is the modality of choice to assess extent of disease and to evaluate for chest wall involvement [68, 69]. 6). Fibrosarcoma is a malignant tumor of low-to-intermediate grade that is most common in the adult population aged 40 to 70 years. 3 Limitations primarily relate to evaluation of deep soft tissue structures, bone, and masse. Biopsy. Any non-adipose components must be carefully assessed to exclude a more aggressive component. Ultrasound. Mammographically, tubular adenomas have been associated with tightly grouped microcalcifications, which can be suspicious in morphology and may warrant biopsy [61]. PubMed Central Benign inflammatory breast conditions that mimic malignancy include infectious mastitis and breast abscess, granulomatous mastitis, and lymphocytic mastopathy. In evaluating a soft tissue mass of the extremity, a differential diagnosis can be organized based on location of the mass and age of the patient, Examination technique is important when performing ultrasound of a soft tissue mass. Pathol Res Pract 190(4):362371, Adrada BE, Krishnamurthy S, Carkaci S, Posleman-Monetto FE, Ewere A, Whitman GJ (2015) Unusual benign tumors of the breast. The clinical and imaging features of granular cell tumor are indistinguishable from those of breast cancer. No evidence of malignancy. Radiology. Sonographic features of breast abscesses include one or more hypoechoic collections of variable shapes and sizes that are often continuous and multiloculated (Fig. PubMed Central The reason why any lesion is visible on mammography or USG is the relative difference in the density and acoustic impedance of the lesion, respectively, as compared to the surrounding breast tissue. What does hyperechoic indicate? In one study, PASH was seen in up to 23% of biopsied cases which reflects its wide spectrum of imaging findings [47]. Eur Radiol 11(11):22362240, Memis A, Bilgen I, Ustun EE, Ozdemir N, Erhan Y, Kapkac M (2002) Granulomatous mastitis: imaging findings with histopathologic correlation. As a malignant mass enlarges, especially if high grade, it becomes more heterogeneous with hypoechoic areas of internal necrosis and increased flow on color and power Doppler imaging. How Ultrasound Works Types of Ultrasound Images Are Hypoechoic Masses Cancerous? J Clin Med 9(4):958, CAS Longitudinal grayscale ultrasound (b) shows a non-parallel irregular hypoechoic mass (arrow). Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast entity that presents with a wide spectrum of imaging features. In addition, ultrasound evaluation of the axillary lymph nodes, in cases where malignancy is the primary consideration, is more likely to show markedly abnormal lymph node enlargement with the characteristic cortical thickening and hilar displacement of metastatic lymph nodes. Imaging Characteristics of Deep-Seated Lipomatous Tumors: Intramuscular Lipoma, Intermuscular Lipoma, and Lipoma-Like Liposarcoma. Associated skin thickening and edema have also been described [11]. Intramuscular lipomas may invade and interdigitate with the associated skeletal muscle, resulting in a characteristic striated appearance that may help distinguish them from liposarcoma 5. Like fibroadenomas, tubular adenomas are not known to increase the risk of cancer, and in contrast to fibroadenomas, are not associated with pregnancy or oral contraceptiveuse [59, 60]. SA J Radiol 22(2):1366, Bowman E, Oprea G, Okoli J et al (2012) Pseudoangiomatous stromal hyperplasia (PASH) of the breast: a series of 24 patients. These are sometimes known as infiltrating lipomas. Radiology 198(1):117120, Solomou E, Kraniotis P, Patriarcheas G (2012) A case of a giant pseudoangiomatous stromal hyperplasia of the breast: magnetic resonance imaging findings. Jamshid Tehranzadeh. Lymphocytic mastopathy has also been described in the absence of an underlying systemic condition. Nguyen et al. It is more commonly found in the head and neck and chest wall regions, with only 4%-6% of cases located in the breast [76, 77]. Six-month follow-up mammography and ultrasound were recommended and demonstrated stability, Stromal fibrosis. Isoechoic - Tissue or structures which produces an echo of the same strength as that of the surrounding structures or tissues, making it difficult to isolate. As inflammatory breast cancer is the most important differential consideration with this clinical presentation, caution must be exercised to exclude an underlying malignancy. Mod Pathol 16(3):223228, Goulabchand R, Hafidi A, Van de Perre P et al (2020) Mastitis in autoimmune diseases: review of the literature, diagnostic pathway, and pathophysiological key players. AJR Am J Roentgenol 179(5):12011203, Tuncbilek N, Karakas HM, Okten O (2004) Diabetic fibrous mastopathy: dynamic contrast-enhanced magnetic resonance imaging findings. Ultrasonography can be used to assess size, depth, solid or cystic nature, and associated vasculature. 12g). Breast J 11(6):454456, Ely KA, Tse G, Simpson JF, Clarfeld R, Page DL (2000) Diabetic mastopathy. All biopsies showed dense stromal fibrosis, chronic inflammation, and features suggestive of granulomatous mastitis without atypia or malignancy. 13) [61]. On MRI, the two most common findings are masses with circumscribed margins and rim enhancement and heterogeneous non-mass enhancement in a segmental or regional distribution (Fig. Lipoma. A small amount of non-adipose components are often present, representing fibrous septa, areas of fat necrosis, blood vessels, and interposed muscle fibers. Reference article, Radiopaedia.org (Accessed on 28 Jun 2023) https://doi.org/10.53347/rID-7654, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":7654,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/lipoma/questions/2578?lang=us"}. Benign tumors that mimic malignancy include hamartoma, pseudoangiomatous hyperplasia, tubular adenoma, desmoid fibromatosis, and granular cell tumor. Lymphocytic mastopathy is a perivascular and perilobular inflammatory process of the breast parenchyma incited by the infiltration of lymphocytes [21,22,23,24]. Lipomas appear as soft variably echogenic masses, commonly encountered on ultrasound. Therefore, evaluation of sampling adequacy and establishing radiologic-pathologic correlation in these cases is of utmost importance. Extra-nodal lymphoma of soft tissues most commonly appears as a hypoechoic mass with infiltrative margins and significantly increased vascularity on color and power Doppler imaging. If the radiographic presentation is of a circumscribed mass or amorphous or punctate calcifications in a grouped distribution with adequate sampling, a pathologic diagnosis of sclerosing adenosis can be considered concordant. Nonpuerperal abscesses can pose a diagnostic challenge and are more commonly seen in younger women. Size and location should be described. 12e, f) [42, 43, 48]. The recommendations in this statement are based on analysis of current literature and common practice strategies. Additionally, MRI is better able to demonstrate the surrounding anatomy. When no suspicious features are present, the diagnosis of lipoma can be made with confidence with MRI being 100% specific 1. This is exemplified in women with dense breast tissue, where USG is useful in detecting small breast cancers that are not detected on mammography. Br J Radiol 57(673):98101, Leibman A, Kossoff M (1991) Sonographic features of fibromatosis of the breast. Treatment and prognosis. Appropriate radiologicpathologic correlation is essential to avoid delay in proper management. Recognition of these conditions is essential to ensuring careful and accurate radiologic-pathologic correlation, and to formulating a clinical management plan. Color and power Doppler may help distinguish between cystic and solid masses and characterize malignant masses and lymph nodes. 1. Iran J Radiol 13(3):e20873, PubMed Many solid masses demonstrate increased through-transmission, simulating complex cysts. Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts, most common between the ages of 20 and 40 years. In patients with a prolonged course and patients whose condition does not respond to antibiotics, breast biopsy is indicated and should not be delayed. These masses can sometimes be continuous and can appear tubular. T2-weighted sagittal images (e) show moderate T2 signal with marked heterogeneity (arrow). Therefore, close clinical and imaging follow-up is indicated to ensure that there is no interval development of new breast masses [22]. These conditions are clinically important because they closely mimic and are often clinically and radiologically indistinguishable from inflammatory breast cancer [1]. The nodule has smooth, well-defined margins with a very heterogeneous echotexture. Sonograpically, sclerosing adenosis can present as a circumscribed mass, with variable echogenicity. It has a peak incidence in the fifth decade of life, is more common in men, and is the most common radiation-induced soft tissue sarcoma. Grayscale (c) and color Doppler breast ultrasound (d) reveals multiple retroareolar, vascular masses (arrows). Core needle biopsy showed PASH, Suspicious presentation of pseudoangiomatous stromal hyperplasia. . Ultrasound is less expensive and more accessible than magnetic resonance imaging (MRI). McGraw Hill Professional, Eastley N, McCulloch T, Esler C et al (2016) Extra-abdominal desmoid fibromatosis: a review of management, current guidance and unanswered questions. Stromal fibrosis. The first critical distinction is to determine whether the mass originates from a synovial space (joint, bursa, or tendon sheath), as such masses are likely benign and related to a synovial process. Lipomas are benign tumors composed of mature adipocytes. Main cardiac masses consist of thrombi . Grayscale ultrasound (b) shows a corresponding irregular, hypoechoic anti-parallel mass with indistinct margins. The echogenicity of fat in the breast is at the middle of the gray-scale spectrum. In many cases, as with a growing breast mass, surgical excision should be considered to obtain a definitive diagnosis [56]. Proliferative breast conditions that mimic malignancy include fat necrosis, stromal fibrosis, and sclerosing adenosis. For a 2.8-cm one, it . Radiographics 31(6):16831699, Schfer P, Frrer C, Mermillod B (1988) An association of cigarette smoking with recurrent subareolar breast abscess. Presence of T2-hyperintense slit-like spaces with cystic components favors the PASH diagnosis favors the diagnosis of PASH (Fig. Increased through-transmission deep to a nerve sheath tumor is common, arrows in A and between cursors and arrows, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window). A 56-year-old woman with a new focal asymmetry in the outer breast that was identified on her (a) screening mammogram and persisted on (b) additional diagnostic spot compression views (arrows). Ultrasound-guided and MRI-guided biopsies were performed in this case and showed PASH. While the skin thickening associated with inflammatory breast cancer is likely to be diffuse, the thickening associated with breast abscess and mastitis tends to be localized to the area involved with mastitis. An 'angular margin' is an angular configuration at the junction between relatively hypoechoic or isoechoic central portion of a solid mass and surrounding tissue. Tubular adenoma. Recurrence has been reported in patients who undergo surgical excision [21]. She did not have a history of diabetes or other known immunologic condition. Stromal fibrosis is not an uncommon pathologic diagnosis, representing 2%-9% of biopsied breast lesions. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Cite this article. The Desmoid Working Group and European Society for Medical Oncology have provided additional guidance, adding the possibility of active surveillance to the above-stated treatment choices with the supervision of a multidisciplinary team experienced in desmoid fibromatosis tumors. INTRODUCTION While there are many types of solid renal tumors; the most common solid renal masses are renal cell carcinomas (RCCs), angiomyolipomas (AMLs), and oncocytomas. Other benign lesions can be considered in the differential diagnosis of superficial lipomas. Because early . Breast Care 16:7784, Gavriilidis P, Michalopoulou I, Baliaka A, Nikolaidou A (2013) Granular cell breast tumour mimicking infiltrating carcinoma. A rapidly growing mass in the volar forearm suggests nodular fasciitis. In most cases, lymphocytic mastopathy is associated with diabetes; however, other autoimmune disorders such as Hashimotos thyroiditis, Sjgrens syndrome, and systemic lupus erythematosus have also been associated with lymphocytic mastopathy [1, 21, 25, 26]. 10) [41]. Lateral spot compression mammogram (a) shows an irregular, high-density mass with spiculated margins adjacent to the chest wall (arrow). Breast abscess is a complication of infectious mastitis. 10. The main differential is: liposarcoma: low-grade tumors are difficult to differentiate from lipomas, and can have a relatively benign clinical course but suffer from a high rate of recurrence 1. The ultrasound appearances of liposarcomas tend to fall into three categories. A: An isoechoic mass in the periphery of the left kidney was initially missed. Both fibroadenomas and tubular adenomas present as circumscribed masses and are occasionally palpable. An isoechoic nodule replaces the right lobe of the thyroid. In some cases, multiple lipomas are associated with syndromes and other diseases, including: Diagnostic criteria according to the WHO classification of soft tissue and bone tumors (5th edition)10: essential: yellow-tan circumscribed mass; uniform proliferation of mature adipose tissue with atypical hyperchromatic stromal cells, desirable: absence of giant marker/ring chromosomes / MDM2 amplification, ADVERTISEMENT: Supporters see fewer/no ads. Breast abscesses typically demonstrate a thick echogenic rim and increased vascularity, suggesting malignancy [2]. In some cases, they may indicate an infection. Doctors can diagnose a mass on the kidney using. Google Scholar, Fletcher A, Magrath IM, Riddell RH, Talbot IC (1982) Granulomatous mastitis: a report of seven cases. With the advent of tomosynthesis, stromal fibrosis can present as architectural distortion. Core needle biopsy showed desmoid fibromatosis. 7). On ultrasound, spiculations will often consist of straight lines that 'radiate' in a perpendicular fashion from the surface of the breast mass. Consider biopsy of any round cyst-appearing mass that does not correspond to a bursa, especially if large, for confirmation of the diagnosis. The patients symptoms improved over the following 6months. Mediolateral oblique mammogram (a) shows a high-density well-circumscribed mass (arrow). The etiology of lipomas is unknown 10. Grayscale (d) and power Doppler (f) ultrasound images reveal an irregular mass with posterior acoustic shadowing corresponding to the palpable area. Therefore, histopathology remains key for confirmation of this diagnosis. Management should be determined by the clinical examination, imaging studies, and core biopsy results [62]. Google Scholar, Jagannathan DM (2015) Benign granular-cell tumor of the breast: case report and literature review. There is associated axillary adenopathy (solid arrow in e). Color Doppler imaging has been used to characterize masses and tumor vascularity. Variable appearance: May be homogenous hyper-, hypo-, or isoechoic lesion ; Central hyperechoic area (central scar) Hypo- or isodense on noncontrast imaging with a central scar ; Hyperdense during the arterial phase ; Typically isodense during the portal venous phase, although the central scar may become hyperdense as contrast diffuses into the . When PASH is identified as a mass on imaging or is the targeted lesion on biopsy, then surgical excision can be considered for larger lesions (>2cm) and for women with an increased risk of developing breast cancer or strong family history [43, 54, 55]. The patient underwent three core needle breast biopsies of the mass in the left breast over the span of a month, and a skin punch biopsy. On sonography, a hypoechoic mass with irregular or circumscribed margins is usually seen. Core needle biopsy showed acute and chronic inflammation and granulation tissue. Desmoid fibromatosis. Solid and complex cystic masses detected on ultrasound require further imaging evaluation with CT and/or MRI for proper characterization. Spot compression tangential (a), mediolateral (b), and craniocaudal (c) mammographic views did not show a corresponding abnormality. 11a, c) [43]. Core needle biopsy yielded granular cell tumor which was treated with surgical excision. Although leiomyomas are uncommon outside the uterus and gastrointestinal tract, they may be found in the extremities and take one of three forms: cutaneous leiomyoma (most common, located in the dermis), angioleiomyoma (located in the subcutaneous tissues), and leiomyoma of deep tissues. Cancer 63(6):11541160, Jones KN, Glazebrook KN, Reynolds C (2010) Pseudoangiomatous stromal hyperplasia: imaging findings with pathologic and clinical correlation. The significance of isoechoic prostatic carcinoma J Urol. The second ultrasound appearance relates to the myxoid subtype, which is the second most common type of liposarcoma. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 3. Additional history gained during the ultrasound examination often adds insight to narrow the differential diagnosis. Craniocaudal (a) and lateral (b) spot compression mammographic views show an oval non-calcified mass with angular margins (arrows). 4). Conversely, a fibroadenoma has an extensive connective tissue component. On sonography, it has a more variable appearance, from the more common and benign-appearing oval, circumscribed hypoechoic mass (Fig. Typical benign imaging features do not require further workup. An inflammatory or infectious etiology such as plasma cell mastitis, granulomatosis with polyangiitis, sarcoidosis, or tuberculous mastitis must be excluded [11]. Color Doppler ultrasound (c) shows increased vascularity, edema (arrow head), and skin thickening (dashed arrow). Kransdorf M, Bancroft L, Peterson J, Murphey M, Foster W, Temple H. Imaging of Fatty Tumors: Distinction of Lipoma and Well-Differentiated Liposarcoma. The imaging features of desmoid fibromatosis are often indistinguishable from those of malignancy. isoechoic solid nodule: 25% (follicular and medullary) hyperechoic solid nodule: 5% chance of being malignant large cystic component favors a benign entity although a significant proportion of papillary carcinomas will have a cystic component Similarly, if suspicious features are present, then the sensitivity of MRI is 100% 1, although specificity is lower, as some masses with atypical features will nonetheless be lipomas. The . A soft tissue mass at the lower pole of the scapula suggests an elastofibroma, and demonstration of a striated appearance confirms the diagnosis and avoids biopsy. T1weighted axial delayed post-contrast (d) and sagittal subtraction (e) post-contrast MRI shows diffuse skin thickening (solid arrow) and trabecular thickening with heterogenous enhancement involving the left superior breast (dashed arrows). Biopsy is indicated for diagnosis. Fat necrosis. Malignant fibrous histiocytoma or undifferentiated pleomorphic sarcoma is the most common soft tissue sarcoma. Spontaneous resolution has been reported in about half of patients [20]. Granular cell tumor has a predilection for premenopausal and African American women and is preferentially found in the upper inner quadrants of the breast. In contradistinction, intermuscular lipomas do not exhibit local invasion and tend to be lobular or dumbbell-shaped, easily separated from adjacent soft tissues during surgical resection 6,7. Provided by the Springer Nature SharedIt content-sharing initiative. Murphey M, Carroll J, Flemming D, Pope T, Gannon F, Kransdorf M. From the Archives of the AFIP: Benign Musculoskeletal Lipomatous Lesions. Your privacy choices/Manage cookies we use in the preference centre. 3e). Floating the transducer on a thick layer of gel helps to demonstrate soft tissue swelling or a very superficial mass. Superficial lipomas are usually <5 cm whereas deep lipomas can be >20 cm 10. A 41-year-old woman presented with a palpable breast mass. statement and (2008) ISBN: 9780071465427 -, 4. Grayscale transverse (c) and longitudinal (d) ultrasound show a mixed-echogenicity oval mass correlating with the mammographic finding (arrows). Breast J 10(4):359362, Tayyab SJ, Adrada BE, Rauch GM, Yang WT (2018) A pictorial review: multimodality imaging of benign and suspicious features of fat necrosis in the breast. These may represent areas of fat necrosis, fibrous tissue, blood vessels, or muscle fibers; these lesions cannot be confidently differentiated from liposarcoma by imaging.
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