Imaging and Management of Unusual Breast Neoplasms

Unusual malignant tumors of the breast: MRI features and pathologic correlation

Invasive ductal carcinoma and ductal carcinoma in situ account for about 85% of breast cancers. Unusual breast neoplasms may be broadly divided into invasive lobular carcinoma, well-differentiated subtypes of invasive ductal carcinoma, cancers of stromal origin, and metastatic neoplasms. Clues are often present in imaging characteristics, patient demographics, and/or clinical features that may suggest that the finding is not the usual type of breast cancer. Some rare malignancies also provide specific clues to their diagnosis. This review provides an overview of unusual and a few rare malignant breast neoplasms, highlighting particular or specific clinical or imaging findings that will enable residents to expand their differential diagnosis of breast lesions beyond invasive ductal carcinoma.

With the growing awareness and availability of proper screening methods, detection of breast lump is increasing globally and is now a very sensitive issue for females. The treatment of these lumps ranges from lumpectomy to wide local excision to mastectomy; hence, a proper diagnosis is very important to prevent under- or overtreatment in patients. Breast lesions are the heterogeneous diseases encompassing several distinct entities with remarkably different characteristics. While the more common forms of breast cancers are well recognized and understood better, there are many important unusual lesions and malignancies that are less known and less appreciated and can be challenging to diagnose. In such cases, due to rarity of the disease and lack of adequate treatment protocol, managing the patients can be a challenging task for surgeons and oncologist as well. In this article, we have shared our institutional experience in unusual breast lesions with emphasis on diagnostic as well as management challenges faced.

Unusual breast neoplasms encompass a host of heterogeneous benign, borderline, and malignant entities, which often pose a management challenge when encountered on pathologic analysis after image-guided biopsy. Entities to be discussed in this article include select lesions of fibroepithelial, mesenchymal, and myoepithelial origin and nonneoplastic inflammatory lesions. Our objective is to discuss the imaging characteristics of these uncommon lesions and review management guidelines to facilitate radiologic-pathologic correlation and postbiopsy recommendations.

Unusual breast neoplasms encompass a host of heterogeneous benign, borderline, and malignant entities, which often pose a management challenge when encountered on pathologic analysis after image-guided biopsy. Entities to be discussed in this article include select lesions of fibroepithelial, mesenchymal, and myoepithelial origin and nonneoplastic inflammatory lesions. Our objective is to discuss the imaging characteristics of these uncommon lesions and review management guidelines to facilitate radiologic-pathologic correlation and postbiopsy recommendations.

Contemporary Diagnostic Radiology 41(11):p 6, May 31, 2018. | DOI: 10.1097/01.CDR.0000533587.26110.da

Malignant phyllodes tumor is an unusual breast neoplasm. A 22-year-old woman was admitted to the hospital because of a small lump (3×3cm) in the area AC of the left breast. As the lump was extirpated and found to be malignant phyllodes tumor, a wide resection was performed. The most important therapy for malignant phyllodes tumors of the breast is surgical resection, and mastectomy with lymph node dissection has been principally employed in former times. The tumor, however, hematogenously metastasizes and recurs locally with unsatisfactory resection, and lymph node metastasis rarely occurs. Recently breast conservative surgical method tends to be indicated. In this case, the tumor was relatively small as the phyllodes tumor and the patient was unmarried young woman, and we chose a conservative surgical method. After the operation, a total cross section confirmed that surgical margin was free. Because no effective chemotherapy for malignant phyllodes tumor has been established as yet, adjuvant chemotherapy was not employed. The patient is now doing well with no evidence of recurrence, as of 20 months after the surgery. However, careful follow-up study of local recurrence and distant metastasis would be mandatory.

Primary breast lymphoma (PBL) is a rare clinical entity. The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma. As a result, the diagnosis of PBL...

Sonography of Unusual Breast Neoplasms

Cystosarcoma phyllodes is an unusual breast neoplasm that rarely metastasizes. Most series report chemotherapy, radiation, and hormonal therapy to be ineffective. Three patients were treated with cisplatin and etoposide combination chemotherapy with effective palliation in two patients. Radiation therapy was effective in controlling symptomatic metastasis in all three patients. Hormonal therapy was ineffective in two patients despite the presence of positive hormone receptors. Chemotherapy and radiotherapy may be more effective in the treatment of this tumor than has been reported, although there is no apparent role for hormonal therapy. Functional hormone receptors are probably not present.

An unusual breast tumour occurring six years after a similar tumour in the contralateral breast

A 60-year-old woman presented with a painless lump in the left breast. A solitary movable mass in the left upper–outer quadrant of the breast was palpated on physical examination. It...

Fibromatosis of the breast; another diagnosis of cancer like lesions: About 4 cases reports

BackgroundBreast metastases from pulmonary large-cell neuroendocrine carcinoma (LCNEC) often mimic benign tumors, making diagnosis challenging due to their rarity.Case presentationA 49-year-old female presented with bilateral breast masses noticed during self-examination for three weeks. Given the benign appearance of the lesions, same-day en bloc resection was planned without preoperative biopsy. Consequently, the patient underwent bilateral mastectomy and axillary surgery based on intraoperative frozen section results, which suggested a possible primary high-grade invasive breast cancer, but no metastatic workup was performed beforehand. Postoperatively, she was diagnosed with LCNEC, with bilateral breast and multiple systemic metastases, leading to an unnecessary surgery.ConclusionsThorough preoperative evaluation is essential for unusual breast tumors to differentiate between primary and secondary lesions. Maybe pulmonary neuroendocrine carcinoma in the lower lobe more commonly metastasizes to the breast through hematogenous spread, while upper lobe lesions typically spread via lymphatic routes.

A patient with an unusual breast tumour is presented. The clinical features and pathology are described, followed by a brief review of the literature.