Methotrexate (MTX)-associated malignant lymphoma of the bilateral breast: imaging features in comparison to other nipple-areolar tumors.

Tumors originating from the nipple-areolar complex of the breast are rare. We herein report the case of a patient with metachronous bilateral areolar methotrexate (MTX)-associated lymphoma. The patient was a 67-year-old woman who presented with a rapidly enlarging tumor in the areolar region of her left breast. She had a long history of rheumatoid arthritis and had taken MTX for many years. On ultrasonography, the tumor showed well-demarcated margins and hyper-vascularity. On magnetic resonance imaging, the tumor showed a homogeneous low-to-moderate signal intensity that was similar to that of the nipple on both T1- and T2-weighted imaging; the diffusion was significantly reduced on diffusion-weighted images. The tumor showed a medium-plateau pattern on dynamic contrast-enhanced imaging. No necrotic change was observed. Based on the imaging findings, we considered the tumor to have originated from the areola. According to the internal homogeneity, the rapid growth and hyper-cellularity, the potential diagnoses included a small round cell tumor (including malignant lymphoma) and a mesenchymal neoplasm (especially leiomyoma or leiomyosarcoma, which frequently originate from the areolar region). An excisional biopsy of the tumor was performed. The pathological diagnosis was diffuse large, non GC B-cell lymphoma that we suspected was associated with MTX. The tumor shrank rapidly after the withdrawal of MTX. After three months, we detected a B-cell lymphoma of the same type originating in the contralateral areola. We compared the characteristics of the imaging findings of the MTX-associated lymphoma with the nipple-areolar or periareolar tumors and primary breast lymphoma.

Ductal adenoma of breast: imaging characteristics and radiologic-pathologic correlation of unique findings which reflect "pseudoinvasion".

PURPOSE: To investigate the imaging characteristics of rare ductal adenoma of the breast, we evaluated the detailed imaging findings and correlated them with the pathologic features of the ductal adenomas. In particular, we describe in detail the imaging findings derived from "pseudoinvasion," one of the histological features unique to this tumor. MATERIALS AND METHODS: We reviewed the imaging findings including magnetic resonance imaging (MRI) in three patients with ductal adenomas of the breast and correlated the findings with the detailed histological features. RESULTS: All patients exhibited well-demarcated nodules with smooth margins on mammography. On ultrasonography, two patients exhibited mural nodules within cysts. The bases of mural nodules protruded into the mammary glands. On contrast-enhanced MRI, these margins were smooth. Histologically, the bases showed foci of tumor cells scattered into collagenous materials (pseudoinvasion), the tumor foci were located along the collagen fibers; therefore, the margins were smooth. CONCLUSIONS: Distinguishing ductal adenoma from invasive carcinoma is an urgent issue. A clear margin of 'pseudoinvasion' on MRI is both a unique finding and a useful diagnostic clue.

Breast carcinoma originating from a silicone granuloma: a case report.

Breast carcinoma rarely occurs in cases of foreign body granulomas following liquid silicone injection. Although the Food and Drug Administration (FDA) banned the use of all silicone injection products in 1992, liquid silicone injection for breast augmentation continues to be performed illegally. We herein report a case of breast carcinoma following liquid silicone injection in a 67-year-old female.A total of 45 years after liquid silicone injection, the patient had felt a breast mass in the right breast. Mammography showed a smooth mass that retracted the right nipple. Due to the presence of a marked acoustic shadow caused by the granulomas, evaluating the mass on ultrasonography was difficult. However, magnetic resonance imaging (MRI) showed a lobulated mass under the right nipple. The mass exhibited low signal intensity (SI) on T1-weighted images and intermingled high and low SI on T2-weighted images. Heterogeneous early enhancement with central low intensity was noted on dynamic contrast-enhanced MRI. Several oval-shaped low SI structures in the adipose tissue and disruption of the pectoralis major muscle were also observed. We diagnosed the patient with invasive ductal carcinoma based on a stereotactic-guided Mammotome® (a vacuum-assisted biopsy system manufactured by DEVICOR MEDICAL JAPAN, Tokyo, Japan) biopsy and subsequently performed mastectomy and axillary lymph node dissection (with a positive result for the sentinel node biopsy). Histologically, invasive ductal carcinoma was observed in the silicone granuloma.The development of foreign body granulomas following breast augmentation usually makes it difficult to detect breast cancer; thus, various devices are required to confirm the histological diagnosis of breast lesions. The stereotactic-guided Mammotome® biopsy system may be an effective device for diagnosing breast cancer developing in the augmented breast.

Magnetic resonance imaging manifestations of ovarian mullerian mixed epithelial borderline tumors: imaging and histologic features in comparison with mullerian mucinous borderline tumors.

We illustrate the magnetic resonance imaging features of 3 cases of rare ovarian Mullerian mixed epithelial borderline tumor (MEBT) and identify important diagnostic clues based on their detailed histologic, morphologic, and clinical features. Mullerian mixed epithelial borderline tumor has good prognosis, and adequate management is essential. In order to avoid unnecessary aggressive treatment, radiologists should become familiar with the imaging findings of MEBT. To the best of our knowledge, no articles have described the detailed images of MEBT.

Breast ultrasound elastography and magnetic resonance imaging of fibrotic changes of breast disease: correlations between elastography findings and pathologic and short Tau inversion recovery imaging results, including the enhancement ratio and apparent diffusion coefficient.

PURPOSE: Ultrasound (US) elastography provides information regarding tissue hardness and is expected to become a novel diagnostic tool for breast disease. In contrast, magnetic resonance (MR) images reflect the tissue characteristics. Fibrosis of the stroma of breast diseases may affect their hardness. We investigated the correlation among elasticity score (ES) and signal intensity of short Tau inversion recovery MR images, enhancement ratio, apparent diffusion coefficient (ADC), and the fibrosis in the breast lesions. MATERIALS AND METHODS: We reviewed the findings of US elastography and MR imaging from 41 consecutive patients with breast lesions (25 invasive ductal carcinoma, 3 fibroadenoma, 1 phyllodes tumor, 2 ductal hyperplasia, 2 primary malignant lymphoma, 3 mastopathy, 1 metastasis, 1 tubular adenoma, 1 ductal carcinoma in situ, 1 diabetic mastopathy, and 1 intraductal papilloma). In each patient, elastography images were classified based on Tsukuba ES. We calculated the ratio of signal intensity of the lesion to the muscle on short Tau inversion recovery images (L/M ratio), enhancement ratio of early to precontrast and early to delayed images, and ADC for each lesion. The ES and MR findings were correlated with the degree of fibrosis (based on Masson trichrome stain). RESULTS: The ES significantly correlated with the L/M ratio (P = 0.0306) and the ADC (P = 0.0256). The stromal fibrosis also correlated with ES (P = 0.0023), the L/M ratio (P = 0.0344), and enhancement ratio of the early-to-delayed images (P = 0.049). CONCLUSIONS: The ES and L/M ratio are correlated significantly with each other, and they are correlated with the fibrosis. These results suggest that they will provide the information on the fibrosis and may help the diagnosis of breast lesions.

MR imaging of malignant primary breast lymphoma: including diffusion-weighted imaging, histologic features, and a literature review.

OBJECTIVE: To investigate the magnetic resonance (MR) imaging characteristics of malignant primary breast lymphoma (PBL), including features on diffusion-weighted imaging (DWI). METHODS: The MR findings of three patients were reviewed retrospectively at our institutions. The signal intensity, shape, enhancement pattern, and DWI findings were examined and correlated with the histologic features. We also reviewed the MR findings of cases of PBL reported in the literature. RESULTS: The tumors in our cases showed early enhancement with penetrating vessels on early-phase dynamic MR images and a strong high signal intensity on DWI. The tumors had a cerebroid appearance and septal enhancement on delayed contrast-enhanced MR images, and we speculate that the fibrous tissue seen in the tumors may correspond to septal enhancement. After chemotherapy, all lesions decreased in size, while the ADCs were increased. All of the cases reported in the literature showed early or avid enhancement; this finding was similar to that observed in our cases. CONCLUSIONS: Although based on a small number of cases, we suggest that strong enhancement with penetrating vessels in masses on early images of dynamic MR, strong high intensity on DWI, a cerebroid appearance, and septal enhancement are useful diagnostic clues for a diagnosis of PBL.

Apparent Diffusion Coefficient in Invasive Ductal Breast Carcinoma: Correlation with Detailed Histologic Features and the Enhancement Ratio on Dynamic Contrast-Enhanced MR Images.

Purpose. To investigate the correlation of Apperent Diffusion Coefficient (ADC) values in invasive ductal breast carcinomas with detailed histologic features and enhancement ratios on dynamic contrast-enhanced MRI. Methods and Materials. Dynamic MR images and diffusion-weighted images (DWIs) of invasive ductal breast carcinomas were reviewed in 25 (26 lesions) women. In each patient, DWI, T2WI, T1WI, and dynamic images were obtained. The ADC values of the 26 carcinomas were calculated with b-factors of 0 and 1000 s/mm(2) using echoplanar DWI. Correlations of the ADC values were examined on dynamic MRI with enhancement ratios (early to delayed phase: E/D ratio) and detailed histologic findings for each lesion, including cellular density, the size of cancer nests, and architectural features of the stroma (broad, narrow, and delicate) between cancer nests. Results. The mean ADC was 0.915 ± 0.151 × 10(-3) mm(2)/sec. Cellular density was significantly correlated with ADC values (P = .0184) and E/D ratios (P = .0315). The ADC values were also significantly correlated to features of the stroma (broad to narrow, P = .0366). Conclusion. The findings suggest that DWIs reflect the growth patterns of carcinomas, including cellular density and architectural features of the stroma, and E/D ratios may also be closely correlated to cellular density.

[A case of triple negative chest wall recurrent breast cancer treated with capecitabine and docetaxel combination therapy (XT therapy)].

A 59-year-old woman underwent modified radical mastectomy for left breast cancer 9 years earlier. This time, a chest wall recurrence was found. A chest CT showed a chest wall tumor and lymph node metastases. PET images showed increased uptake in chest wall tumor and lymph nodes. The serum tumor markers have also elevated. Open biopsy of chest wall tumor was performed, and the tumor was diagnosed as invasive ductal carcinoma[ER(-), Pg R (-), HER2 score(0)]. Combination chemotherapy with capecitabine and docetaxel was initiated. After 7 courses of treatment, a marked response has been seen. Capecitabine and docetaxel combination therapy are considered useful for treatment of triple negative recurrent breast cancer.

Adenoma of the nipple: correlation of magnetic resonance imaging findings with histologic features.

Adenoma of the nipple (nipple adenoma) is a rare breast tumor that can show various histologic features. We present magnetic resonance (MR) and other imaging findings of a case of nipple adenoma and correlate them with detailed histologic features of the tumor. The lesion showed early strong enhancement with rim enhancement on dynamic contrast-enhanced MR images, and internal portions of the lesion showed washout on delayed MR images. Histologically, the tumor showed expansive growth with surrounding dense collagenous tissue and large vessels. Internal portions of the lesion showed a relatively low degree of fibrosis compared with that of the surrounding area, and tiny vessels were observed. These features were clearly reflected in the MR findings.