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ОглавлениеCase 15
Case History
A 65-year-old woman presents for her first mammogram.
Physical Examination
• normal exam
Mammogram
Mass (Fig. 15–1)
• margin: circumscribed
• shape: oval
• density: equal density
Figure 15–1. In the inferior medial left breast, there is an oval mass with a single round calcification. The spot compression view suggests that the margins are ill defined. (A). Left MLO mammogram. (B). Left CC mammogram. (C). Left MLO spot compression mammogram.
Ultrasound
Frequency
• 7.5 MHz
Mass
• margin: well defined
• echogenicity: heterogeneous
• retrotumoral acoustic appearance: posterior shadowing distal to mass
• shape: ellipsoid (Fig. 15–2)
Figure 15–2. Left radial breast sonogram: At the 8:00 position of the left breast there is a well-defined oval mass of heterogeneous (predominantly hyperechoic) echogenicity.
Pathology
• fibrocystic change
• hyalin sclerosis (fibrosis)
Management
• BI-RADS Assessment Category 4, suspicious; biopsy should be considered
Pearls and Pitfalls
1. The recommendation for biopsy is based on the mildly ill-defined mammographic margins and the mildly heterogeneous sonographic echogenicity.
2. When fibrocystic changes produce a circumscribed mammographic mass, the sonographic findings correspond to either a cyst or a focal solid mass. The sonographic appearance of a solid mass is variable and biopsy is generally required. The sonographic fibrocystic masses may be either well or ill defined. They may be hyperechoic, hypoechoic, or heterogeneous echogenicity.
Suggested Readings
1. Love SM, Gelman RS, Silen W. Fibrocystic “disease” of the breast—a non-disease. N Engl J Med 1982;307:1010–1014.
2. Teboul M, Halliwell M. Atlas of Ultrasound and Ductal Echography of the Breast. 2nd ed. Cambridge: Blackwell Science; 1996:106–110, 180–185.
3. Tohno D, Cosgrove DO, Sloane JP. Benign breast change. In: Tohno D, Cosgrove DO, Sloane JP, eds. Ultrasound Diagnosis of Breast Diseases. New York: Churchill Livingston;
