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Case 8

Case History

A 68-year-old woman presents with a new mass on her left screening mammogram.

Physical Examination

• normal exam

Mammogram

Mass (Fig. 8–1)

• margin: circumscribed

• shape: oval

• density: equal density

Figure 8–1. At the 12:00 position of the left breast and the 3:00 position of the right breast there are two oval masses (arrows). The spot compression views demonstrate that the margins of the right mass are well defined and the margins of the left mass are ill defined. (A). Right MLO mammogram. (B). Left MLO mammogram. (C). Right CC mammogram. (D). Left CC mammogram. (E). Right CC spot compression mammogram. (F). Left CC spot compression mammogram.

Ultrasound

Frequency

• 10 MHz

Mass

• margin: ill defined

• echogenicity: hyperechoic

• retrotumoral acoustic appearance: no shadowing

• shape: ellipsoid (Figs. 8–2 and 8–3)

Figure 8–2. Right radial breast sonogram: The right mammographic mass identified in Figure 8–1 corresponds to an oval well-defined hyperechoic mass.

Figure 8–3. Left radial breast sonogram: The left mammographic mass identified in Figure 8–1 corresponds to a hyperechoic mass similar to the right breast mass.

Pathology

• angiolipoma

Management

• BI-RADS Assessment Category 4, suspicious; biopsy should be considered

Pearls and Pitfalls

1. Uniformly hyperechoic sonographic masses are generally benign, but the Category 4 (suspicious) assessment is based upon the information that the masses are new and the left mass is mildly ill defined mammographically.

2. Clinically, angiolipomas resemble lipomas. Over 75 % of patients are older than 50 years. Angiolipomas in other sites of the body generally are associated with pain. However, breast angiolipomas are generally painless. Microscopically, the mass consists of mature lipocytes associated with an extensive vascular network. Microthrombi are a prominent feature of the lesion. This mass is benign and does not recur.