Mammographic and sonographic findings in the breast and axillary tail following a COVID-19 vaccine

Axillary lymphadenopathy on breast imaging after recent coronavirus disease 2019 (COVID-19) vaccination has been reported in the literature as immunization has become more widespread. While muscle edema at the injection site has been observed on MRI secondary to an immune response, ipsilateral breast imaging observations of edema have not been reported to be seen with the COVID-19 vaccinations to date. Mammographic findings such as trabecular and skin thickening, along with increased echogenicity on ultrasound, can be seen with edema secondary to capillary leak or poor lymphatic drainage, and should be considered as a possible etiology for the observed breast edema following a recent COVID-19 vaccine. Inflammatory changes observed in the breast and axillary tail post vaccination described in this case series are transient, but clinically relevant for patients who experience swelling following injection. Similar to evaluations for suspected mastitis, a short interval imaging follow up to confirm resolution may be appropriate for patients with ipsilateral vaccination histories, and could potentially reduce the number of false positive examinations in this clinical scenario. However, inflammatory breast cancer can mimic inflammation and infection, therefore close follow up to resolution is critical as to not miss cancer.     

Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis

The aim of this study was to describe the mammographic and sonographic findings of idiopathic granulomatous mastitis which is a rare inflammatory disease of the breast of unknown etiology. The clinical, radiologic, and pathologic features of 12 cases with idiopathic granulomatous mastitis were retrospectively reviewed. Mammography was performed in all cases, 8 of which showed a focal asymmetric density, 3 had a mass with irregular margins, and 1 had no abnormality. Sonography was performed in 10 cases, and a focal area with inhomogeneous and hypoechoic pattern was depicted in 6 cases, 4 of which were associated with internal tubular hypoechoic structures. One case revealed a hypoechoic mass consistent with malignancy. In 1 case sonography showed an edematous pattern involving nearly the entire breast. Two patients had normal sonograms. If a focal asymmetric density is seen in mammography and inhomogeneous hypoechogenity with internal hypoechoic tubular structures accompany ultrasonographically, these findings should suggest the possibility of idiopathic granulomatous mastitis; however, very often idiopathic granulomatous mastitis mimics a breast carcinoma clinically and the final diagnosis should be reached histopatologically due to high false-positive and false-negative mammographic appearances. Electronic Publication     

乳腺浸润性导管癌X线表现

目的：分析乳腺浸润性导管癌Ｘ线钼靶检查特征,提高浸润性导管癌的影像学诊断水平。方法：１０５例乳腺浸润性导管癌经手术病理证实,分别摄乳腺Ｘ线钼靶轴、侧位及腋窝斜位片,观察浸润性导管癌影像学特征及腋窝淋巴结表现。结果：①肿块：边缘不规则,分叶、毛刺、星芒状及肿块周围细小结节等（９７．１％）;②钙化：细沙粒样、短小梭形、细条样呈团簇状（５１．４％）;③腋窝淋巴结肿大;形态不规则、分叶、边界不清、密度均匀     

Mammographic and ultrasonographic appearances of lymphoma of the breast

A series of 11 malignant lymphomas of the breast (6 primary non-Hodgkin lymphomas, 4 secondary non-Hodgkin lymphomas, 1 Hodgkin's disease) is reported. Mammography, performed in 10 cases, revealed an ill-defined density (total or partial) (6 cases), a well-defined mass with multicyclic contours (2 cases), a mass with spiculations (1 case) and a false negative (1 case). The sonographic patterns analysed for 7 patients were non-specific, showing a higly hypoechoic, heterogenous mass with marginal irregularity in all cases. There was no correlation between the radiological appearances and the sonographic patterns; the latter were similar for both primary and secondary lesions. In contrast to mammography, ultrasonography has never been used in large literature series for diagnosis of these exceptional sites of lymphoma. Ultrasound also appears useful for patient follow-up to evaluate the response to treatment. Correspondence to: C. Balu-Maestro     

乳腺分叶状肿瘤的X线表现

乳腺分叶状肿瘤(phyllodes tumor of the breast,PTB)是一种少见的由乳腺上皮和纤维组织构成的特殊类型的乳腺肿瘤,主要发生在35～55岁的女性,约占乳腺肿瘤的0.3%～1.0%,纤维上皮性肿瘤的2%～3%[1].良性PTB呈膨胀性生长,交界性和恶性PTB可向周围组织浸润性生长.本文对11例乳腺分叶状肿瘤进行回顾性分析,旨在提高对分叶状肿瘤X线诊断和鉴别诊断的认识.     

Mammographic,sonographic and MR imaging features of invasive micropapillary breast cancer

Purpose

Describe mammographic, sonographic and MRI findings of invasive micropapillary carcinoma (IMPC) of the breast.

Materials and methods

Review of the pathology database identified 43 patients (mean age, 59.3 years) with the diagnosis of breast IMPC. Three patients had no available imaging studies. Mammograms (40), breast ultrasounds (33) and MRIs (8) were retrospectively evaluated by two radiologists in consensus following the BI-RADS Lexicon. Clinical, histopathologic features, as well as hormone status were recorded.

Results

Twenty patients presented with palpable abnormality (20/40, 50%). Thirty-five patients had an abnormal mammogram (87.5%, 35/40) showing 39 lesions, 29 corresponding to masses (29/39, 74.4%), 11 associated with microcalcifications and two associated with architectural distortion. Sonography identified 41 masses (in 33 patients) displaying an irregular shape (30/41, 73.2%), appearing hypoechoic (39/41, 95%), with spiculated or angular margins (26/41, 63.4%), non-parallel orientation (26/41, 63.4%) and combined acoustic posterior pattern (18/41, 44%). MRI identified 13 lesions (in eight patients), 12 as masses (12/13, 92.3%) with irregular or spiculated margins (12/12, 100%), eight displaying an irregular or lobulated shape (8/12, 66.7%), six with homogeneous internal enhancement (6/12, 50%) and eight with type 3 enhancement curve (8/12, 61.5%). Associated non-mass like enhancement was noted in two patients. Twenty-nine patients had associated lymphovascular invasion (29/40, 72.5%) and axillary lymph node metastases were present in 22 of the 39 patients (22/39, 56%).

Conclusion

Invasive ductal carcinoma with IMPC features display imaging findings highly suspicious of malignant lesions. They are associated with high lymphovascular invasion and lymph node metastases rates.     

Gastrointestinal lymphoma: sonographic findings in 54 patients

Between 1980 and 1990, 580 patients with known malignant lymphoma were referred for sonography for evaluation of abdominal masses as a part of the initial staging of the disease. In 54 patients, sonography showed different degrees of hypoechoic bowel wall thickening; gastrointestinal lymphoma was confirmed by histologic examination in all of these patients (non-Hodgkin lymphoma in 50, Hodgkin disease in four). Nineteen of the 54 patients had primary gastrointestinal lymphoma; the other 35 had widespread tumor with secondary gastrointestinal involvement. The portions of gastrointestinal tract involved included the stomach (38), small intestine (five), colon (seven), and multiple sites (four). Several sonographic patterns were found: 39 patients had circumferential involvement of the bowel wall, four had bulky tumors, and two had nodular extraluminal spread. Eight patients had segmental infiltration, and one had mucosal involvement. The results of this study indicate that sonography is of value for examining patients with gastrointestinal lymphoma and that several patterns of involvement can be detected.     

Mammographic and sonographic features of tuberculous mastitis

From December 1999 to April 2001, 10 cases of tuberculous mastitis were presented to the Radiology Unit at the Medical Research Institute of Alexandria University for mammographic and sonographic evaluation. Sixty percent presented with masses, 50% mastalgia, 40% discharge, and 10% complained of skin sinus. In 30% of the patients the complaint was bilateral. All cases underwent full mammographic and ultrasonographic (US) studies, and US-guided fine needle aspiration. Also pathological, bacteriological analysis, and polymerase chain reaction (PCR) were done to all patients to prove the tuberculous nature of their lesions. Thirty percent of the cases had surgical excision on their masses. On mammography 30% were found to have mass lesion mimicking malignant tumors, 40% smooth bordered masses, 40% axillary or intramammary adenopathy, 30% asymmetric density, 30% duct ectasia, 20% with skin thickening and nipple retraction, 20% with macrocalcification, and 10% with skin sinus. On US 60% had hypoechoic masses, 40% focal or sectorial duct ectasia, and 50% axillary adenopathy. History of tuberculosis was found in 30% of the cases. Chest X-ray was positive in 20% and breast magnetic resonance imaging was done to one patient who had skin sinus.     

Mammographic and sonographic spectrum of non-puerperal mastitis

The goal of this study was to explore possible specific mammographic and sonographic features in women with non-puerperal mastitis (NPM), in order to make an accurate diagnosis and prevent unnecessary surgical procedures. From a group of 93 patients with NPM diagnosed between 1987 and 1992, the mammograms of 41, the sonograms and cytology of 47, and the histology of seven patients were retrospectively reviewed. Follow-up was performed on those without histology. In 20 of the 47 patients the inflammation was located subareolarly. In 50% of those with non-subareolar lesions, mammography showed a circumscribed lesion. Sonographically, all patients had an identifiable lesion either well or poorly defined. The majority of the lesions were cystic, but in 23 of 47 cases solid components were seen. Signs of infection in cystic lesions were observed in 25 of 47 cases. Posterior shadowing was not observed. During the follow-up period no breast malignancy was found. It is concluded that NPM has no specific mammographic or sonographic sign. Diagnosis should be made with additional diagnostic assessment, such as FNAB, which was diagnostic in all cases.     

Mammographic and sonographic appearances of nodular adenosis

OBJECTIVE: We determined whether nodular adenosis of the breast possesses any pathognomonic features on imaging studies. CONCLUSION: The imaging features of nodular adenosis are often benign-appearing and can be indistinguishable from other ellipsoid, circumscribed, or hypodense masses. Occasionally, nodular adenosis may appear suggestive of malignancy. Pathologic evaluation by excisional or large core needle biopsy is necessary for diagnosis.     

Angiolipoma of the breast with microcalcification. Mammographic, sonographic, and histologic appearances

Angiolipoma of the breast is a rare benign fatty tumor that can be mammographically confused with breast carcinoma. We herein report such a case presenting as a partial obscured mass with microcalcification on mammogram. Sonogram revealed an encapsulated hyperechoic nodule with homogeneous internal echo. Microscopic evaluation revealed abundant adipose tissues with evidence of proliferating vessels and intravascular hyaline thrombi. To our knowledge, angiolipomas of the breast containing microcalcification secondary to intravascular thrombi had not been previously reported.     

Mondor's disease of the breast: sonographic and mammographic findings

OBJECTIVE: The purpose of this study was to evaluate the mammographic and sonographic findings in patients with Mondor's disease of the breast. CONCLUSION: The combination of a sonographic finding of a superficial vessel-with or without an intraluminal thrombus and without flow on Doppler imaging-and a mammographic finding of a tubular density is the typical sign of Mondor's disease of the breast. Women present with a palpable cordlike structure, which is often painful, especially in the acute phase of thrombophlebitis. An understanding of such an entity and knowledge of the imaging findings will help breast imagers avoid the pitfall of mistaking this finding for a dilated duct.     

乳腺叶状瘤的影像诊断

目的 总结分析乳腺叶状瘤X线钼靶照片和超声检查的影像学特征。方法 搜集1991年1月至2003年5月经手术、病理证实的25例乳腺叶状瘤，其中13例行X线钼靶摄片，17例行超声检查，回顾性分析其临床特点及影像学征象。结果 25例乳腺叶状瘤中病理诊断Ⅰ级者17例，Ⅱ级7例，Ⅲ级1例。13例行乳腺X线钼靶检查患者病灶表现为圆形(7例)或浅分叶状(6例)密度高于邻近腺体的肿块，边界清楚(8例)或部分不清(5例)，所有病例均未发现钙化及邻近皮肤增厚、乳头回缩、周围乳腺结构扭曲等恶性征象。行乳腺超声检查的17例患者，病灶表现为低回声者16例，边界规整者16例，出现囊变者10例，11例出现后方回声增强。结论 乳腺叶状瘤的影像学表现有一定的特点，但这些表现为非特征性，与纤维腺瘤等边界清楚的实性病灶的鉴别有一定的困难，对可疑病灶行切除活检非常必要。     

Calcified pilomatrixoma of the breast: mammographic and sonographic findings

The authors report the ultrasonographic and mammographic features of a case of pilomatrixoma of the breast, a rare benign neoplasm originating from the hair matrix.     

Hepatic lymphoma in cyclosporine-treated transplant recipients: sonographic and CT findings

The purpose of this study was to determine the CT and sonographic features of hepatic lymphoma developing in organ transplant recipients taking cyclosporine. The four patients included in the study had non-Hodgkin lymphoma. Two of the cases were primary, with no associated lymphadenopathy or extrahepatic lesions. The hepatic lymphomas were characterized by multiple low-density areas on CT scans and hypoechoic areas on sonograms. In three of the four patients, the lesions regressed after the cyclosporine dosage was reduced. We conclude that in cyclosporine-treated organ transplant recipients, hepatic lymphoma should be considered in the differential diagnosis of hepatic lesions with or without lymphadenopathy when multiple low-density lesions are shown by CT and hypoechoic lesions are shown by sonography.     

Breast masses. Mammographic and sonographic evaluation.

Asymmetric breast tissue can nearly always be distinguished from a true mass by means of mammographic evaluation. Stellate masses from early invasive breast cancer are often extremely subtle so that optimal technique and meticulous interpretation are essential. Benign stellate masses such as post-biopsy scarring and fat necrosis frequently have a characteristic appearance. A radial scar is usually indistinguishable from malignancy on the mammogram. Nearly all circumscribed masses are benign and are usually cysts, fibroadenomas, or intramammary lymph nodes. A few circumscribed masses represent in situ or invasive carcinoma or both. Characteristics that may allow a definitively benign diagnosis for a circumscribed mass include the presence of fat and certain calcification patterns on the mammogram and features of a simple cyst on the sonogram. Management decisions for other circumscribed masses will depend on characteristics such as shape, margins, calcification, multiplicity, size, stability, and sonographic features as well as patient age and risk factors. Most nonspecific circumscribed masses should be followed rather than biopsied as they are commonly present on mammograms and have a change of malignancy of less than 5%. Even when biopsied on the basis of interval change, most small circumscribed cancers will not have metastasized to the regional nodes. For palpable breast masses, selection of mammography or ultrasonography as the primary imaging modality will depend on patient's age and risk factors.