Objective Analysis of Age-Related Changes in the Superficial Musculoaponeurotic System in Japanese Females Using Computed Tomography.

Background: The superficial musculoaponeurotic system (SMAS) is an anatomical structure involved in facial aging. Objectives: This study focused on SMAS thickness and aimed to establish age-related changes in SMAS thickness. Methods: A total of 100 adult Japanese female participants (aged 20-79 years) were enrolled in the study. The participants were divided into 3 age groups: Y, M, and E, comprising 20 to 39, 40 to 59, and 60 to 79 years, respectively. Anatomical structures were used as landmarks to standardize the SMAS analysis sites. The SMAS in a fixed analysis area (FAA) was quantified using multi-detector computed tomography (MDCT), and the relationship between SMAS thickness and age, as well as BMI, was analyzed. Results: In 96 participants (four were excluded due to imaging artifacts), a moderate yet significant negative correlation was found between the average (A)-SMAS thickness within the FAA and age. The A-SMAS thickness in groups M and E was significantly lower than that of group Y, and the mean value of group E was significantly lower than that of group M. SMAS thickness was greater in the young population. The SMAS gradually became thinner with aging. A statistically significant correlation was not found between SMAS thickness and BMI. Conclusions: Using MDCT technology, age-related changes in SMAS were successfully analyzed. This highly objective analysis method corroborated the aesthetic surgical knowledge of the SMAS features related to facial aging. In clinical applications, our findings may help elucidate the mechanisms involved in facial aging.

Basic Consideration for Facial Aging: Age-Related Changes of the Bony Orbit and Orbicularis Oculi Muscle in East Asians.

BACKGROUND: Age-related changes in the periocular areas are mainly caused by anatomic changes of the bony orbit and orbicularis oculi muscle (OOM). To achieve effective rejuvenation, it is necessary to understand the age-related aspects of these anatomic changes. OBJECTIVES: The aim of this study was to analyze the configuration of the bony orbit and OOM with computed tomography (CT) and to evaluate the effects of aging on these structures. METHODS: A total of 220 orbits and OOMs of 110 Japanese participants (55 males, 55 females) aged 20 to 87 years were enrolled. The long diameter of the orbits, orbital ellipticity, OOM thickness, and OOM attachment to the inferior orbital rim were analyzed. These variables were statistically evaluated for their relationship with age. RESULTS: The long diameter of the orbit was significantly longer in those over than in those under 60 years, with a moderate and significant positive correlation between orbital ellipticity and age. OOM thickness and age showed a strong negative correlation. The degree of OOM attachment to the inferior orbital rim decreased significantly with age. CONCLUSIONS: This study showed that age-related changes of the bony orbit in Japanese individuals tended to be the same as those in Caucasians, but there were differences in the degree of changes observed. As a new finding in the Japanese population, the OOM not only thins with aging, but also gradually loosens from the facial bone. In the elderly, only the nasal side of the OOM was attached to the bone. In clinical applications, this knowledge could contribute to the development of cosmetic surgeries.

Objective analysis of the effectiveness of facial massage using breakthrough computed tomographic technology: A preliminary pilot study.

BACKGROUND: Facial massage is empirically known to be associated with morphological changes, such as improvements in facial sagging. However, quantified objective evaluations of massage-induced changes have not been performed to date. This preliminary pilot study aimed to verify the effectiveness of facial massages by using breakthrough computed tomographic technology. MATERIALS AND METHODS: Five healthy adult volunteers (three women and two men; age, 29-37 years) were enrolled, and computed tomography (CT) examinations using a 320 detectors-spiral CT system known as 320-multidetector-row CT (MDCT) were performed before and after facial massages. Each participant performed a self-massage twice daily for 2 weeks. Massage-induced changes in the cheeks and the superficial musculoaponeurotic system (SMAS) were analyzed by two radiologists on a workstation with a high-accuracy imaging analysis system. RESULTS: After facial massage, the malar top became thinner by -0.8% ± 0.45% and shifted cranially and horizontally over a distance of 3.9 ± 1.94 mm. The SMAS-height, defined as the highest vertical distance of the SMAS, increased by 2.6% ± 2.6%. The change rate in cheek thickness and SMAS-height showed a significant correlation (r = -0.63; P < 0.05). These changes were attributed to the lifting and tightening effects of facial massage. CONCLUSION: We conducted a detailed analysis of the effects of facial massages by using the breakthrough CT technology. Our results provide useful information for beauty treatments and could contribute to the collection of objective scientific evidence for facial massages.

Matching the perforating branch of the internal thoracic artery and the deep inferior epigastric artery for breast reconstruction using multi-detector row computed tomography.

PURPOSE: Matching the diameter of the deep inferior epigastric artery (DIEA) and perforating branch (PB) of the internal thoracic artery (ITA) is important for arterial anastomosis during breast reconstruction using the DIEA flap. An anatomic investigation of these arteries was performed using multidetector row computed tomography (MDCT). PATIENTS AND METHODS: Contrast-enhanced MDCT data of 50 women (aged 18-90 years) covering the neck to the groin were analyzed. The diameter of the PBs of the ITA at their origins from the first to the sixth intercostal space and of the DIEA 20 mm from the bifurcation of the external iliac artery were measured. RESULTS: The mean diameters of the right and left DIEAs were 1.53 ± 0.263 mm and 1.53 ± 0.306 mm, respectively. The diameter of the PBs in the second and third intercoastal spaces was the same as the diameter of the DIEA, bilaterally. CONCLUSION: It is suggested that anastomosis of the DIEA with PBs of the ITA in the second and third intercoastal spaces is optimal for DIEA flap grafting. Our results could contribute to making vascular anastomosis easier, thereby reducing the burden on both surgeons and patients.

Anatomic and diagnostic considerations of facial mobility for understanding the effectiveness of facial massage: A pilot study.

BACKGROUND: The effectiveness of facial massage is often explained by the resulting increases in the blood and lymphatic flow. However, it is difficult to explain the lifting effect on the cheeks. The aim of this study was to analyze facial mobility to further current understanding of the effectiveness of facial massage. MATERIALS AND METHODS: Two kinds of analytical methods were designed using a cadaveric head as well as advanced computed tomography (CT). The cadaveric face was divided into three sections, and three different colors of ink were injected into each section. It was kept in a supine position for 24 hours, and the ink distribution was observed. Upright and supine CT examinations were performed on six healthy adult volunteers. The images of both were superimposed by a three-dimensional image analysis system, and changes in facial contours were analyzed. RESULTS: The three colors of ink spread craniocaudally and were distributed differently from the gravitational vector. When both CT images were superimposed, two distinct lines were formed, which represented overlapping of the facial contours due to the two different CT images. These lines were found to correspond to the border of each color of the ink. CONCLUSION: Focusing on the mobility of the face, the soft tissue of the face had vertical mobility, and it was speculated that this mobility is involved in the effectiveness of facial massage. Our results could provide useful information for cosmetic treatment and contribute to the collection of scientific knowledge for anti-aging medicine.

Basic Consideration for Facial Aging: Analyses of the Superficial Musculoaponeurotic System Based on Anatomy.

BACKGROUND: The superficial musculoaponeurotic system (SMAS) is an important structure to understand for face-lift surgeries. However, the detailed distribution and imaging findings of the SMAS have not been established yet. OBJECTIVES: The aim of this study was to establish the accurate distribution and computed tomography (CT) imaging findings of the SMAS based on cadaveric studies. METHODS: This study was designed in a 3-step procedure. First, 7 cadaver faces were utilized to understand the distribution and histology of the SMAS. Second, the SMAS findings from the cadaveric studies were compared with the CT images. Third, CT images were enrolled for the SMAS interpretation. RESULTS: In 7 cadaveric studies, the SMAS was observed as a subcutaneous fibro-membranous structure extending from the galea aponeurotica to the platysma muscle and laterally connected to the parotid fascia. On the medial side, it also connects with major and minor zygomatic muscles. The SMAS consisted of muscular fibers, collagen fibers, and elastic fibers histologically. Eighteen CT images (all females; age range, 21-82 years) showed the thin linear structures corresponding to the fibro-membranous structures in the cadaveric studies. CT density of the SMAS was similar with that of the muscle, and the SMAS was recognizable in all 18 subjects. CONCLUSIONS: The SMAS is a definite anatomical structure that can be demonstrated as a thin membranous structure on CT. This clinical application could be applicable to the development the cosmetic surgical procedures.

Objective evaluation of the relationship between facial expression analysis by the facial action coding system (FACS) and CT/MRI analyses of the facial expression muscles.

BACKGROUND: There are few reports on the relationship between facial expression formation and mass of the muscle responsible for facial expression. We analyzed the facial expression using facial action coding system (FACS) and examined the muscle mass and characteristics of the facial expression muscles using multi-detector row computed tomography (MDCT) and magnetic resonance imaging (MRI). Moreover, the relation between these was statistically evaluated. MATERIALS AND METHODS: Ten healthy women in their 40s (43.4 ± 3.0 years, 40-49) were enrolled. The expressive faces were analyzed by facial expression analysis software based on the FACS. The muscle mass and characteristics of the facial expression muscles were investigated using MDCT/MRI. The correlation between an integrated expression intensity value (IEIV) for FACS of the widest possible grin and muscle mass was analyzed. The mean values between the two categorized groups (G-1 and G-2) based on fat infiltration into the muscle were compared. RESULTS: A positive correlation is found between the IEIV and the muscle mass. The IEIV of G-1 is significantly larger than the corresponding value of G-2. Hence, the results indicated that the subjects with high IEIV and expressive face had thicker facial expression muscles and little fat infiltration into the muscles. CONCLUSION: Our objective imaging diagnostic study using FACS, MDCT, and MRI corroborated the anti-aging medical science about the facial expression muscles related to youthful facial appearance. The results of this research could contribute to the elucidation of the mechanisms involved in the facial aging process and to the development of cosmetology.

Comparison of diagnostic precision for bone metastasis of primary breast cancer between BONENAVI version 1 and BONENAVI version 2.

OBJECTIVE: The aim of this study was to compare the diagnostic precision of bone scintigraphy with BONENAVI version 1 and BONENAVI version 2 in bone metastasis of primary breast cancer. METHODS: The subjects were 56 consecutive patients (all women, mean age 59 ± 12.7 years) who underwent bone scintigraphy with Tc-MDP and were diagnosed with bone metastasis of primary breast cancer from January 2012 to November 2014. Bone scintigraphy was performed with BONENAVI version 1 and BONENAVI version 2 to calculate artificial neural network (ANN), bone scan index (BSI), and hot-spot values, with ANN ≥ 0.5 considered to reflect bone metastasis for the calculation of sensitivity. Mean ANN, BSI, hot-spot values, and sensitivity were compared between BONENAVI version 1 and BONENAVI version 2, with P < 0.05 considered a significant difference. RESULTS: With BONENAVI version 1, mean ANN was 0.73 ± 0.29, BSI was 1.47 ± 1.85, the hot-spot value was 12.4 ± 12.5, and sensitivity was 76.8% (43/56). With BONENAVI version 2, the mean ANN was 0.86 ± 0.19, BSI was 1.53 ± 2.09, hot-spot value was 12.9 ± 15.6, and sensitivity was 94.6% (53/56). BONENAVI version 2 yielded significantly better ANN and sensitivity than BONENAVI version 1 (both P < 0.01). CONCLUSION: BONENAVI version 2 has improved sensitivity for detecting bone metastasis of primary breast cancer compared to BONENAVI version 1.

Basic analysis of facial ageing: The relationship between the superficial musculoaponeurotic system and age.

BACKGROUND: The superficial musculoaponeurotic system (SMAS) is an anatomical structure involved in the facial ageing process. We aimed to evaluate the SMAS laxity using multi-detector row computed tomography (MDCT) as a diagnostic tool, and to analyse the relationship between SMAS laxity and age. METHODS: Fifty-seven female subjects (aged 21-57 years) were enrolled in the study. The subjects were divided into two age groups: one below the mean age (Group Y, 30 subjects) and one over it (Group O, 27 subjects). The Posture Change (PC)-induced SMAS Laxity Index was measured using reconstructed CT images, and the relationship between the PC-induced SMAS Laxity Index and age was analysed. RESULTS: The PC-induced SMAS Laxity Index was significantly larger in Group O than in Group Y. As well, a strong and significant positive correlation was detected between the PC-induced SMAS Laxity Index and age (r = 0.72; P < 0.001). CONCLUSIONS: The use of MDCT provides insight into the detailed changes associated with ageing that take place within the cheeks. This study objectively demonstrated that SMAS laxity and age are factors associated with facial ageing, as the SMAS laxity increased with age. Finally, the imaging features confirmed the dermatological and aesthetic knowledge gained from plastic surgery regarding the loss of the SMAS supporting force due to facial ageing.

The malaris muscle: its morphological significance for sustaining the intraorbital structures.

The orbicularis oculi muscle, an important mimetic muscle, was investigated to ascertain its anatomical relation to facial aging-especially its orbital part (Oo). Previous studies of the distinct muscle bundles frequently found inferior to the Oo have provided various definitions, including that of the malaris muscle. This study aimed to examine these muscle bundles and clarify their function in facial aging. Twelve heads of Japanese cadavers (average age: 82.5 years old) were dissected to observe the muscles, focusing in particular on those in the periorbital region. Six specimens were further dissected from the inner surfaces to examine the patterns of facial nerve branches under the operating microscope. Histological examinations of two head halves were carried out to investigate the relationship between the muscle bundles and the intraorbital structures. Muscle bundles consisting of lateral, medial, and U-shaped suspending bundles were observed in the region inferior to the Oo. Lateral and suspending bundles were found in all specimens, while the medial bundles were noted in only 9 of 22 specimens. Some branches of the facial nerve penetrated through the lateral, medial, and suspending bundles. The relationship between the suspending bundles and the protruding orbital fat was assessed. The muscle bundles found in this study were regarded as the malaris muscle-a transitional muscle between the superficial and deep facial layers. The suspending bundle may play a role in sustaining the intraorbital structures.

Intracystic magnetic resonance imaging in patients with autosomal dominant polycystic kidney disease: features of severe cyst infection in a case-control study.

BACKGROUND: The purpose of this study was to investigate the usefulness of intracystic MRI features for detection of severe cyst infection that is usually refractory to antibiotic therapy alone in patients with autosomal dominant polycystic kidney disease. METHODS: Seventy-six patients (88 episodes) with positive cyst cultures treated from January 2006 to December 2013 were enrolled as the cases for this case-control study, while 147 patients who continued to attend our hospital from January 2011 to December 2013 and did not have cyst infection diagnosed during that period were enrolled as the controls. Intracystic MRI findings were investigated. RESULTS: At least one of four intracystic MRI features (high signal intensity (SI) on diffusion-weighted images (DWI), fluid-fluid level, wall thickening, or gas) was found in all of the cases, but such findings were also detected in some controls. Intracystic gas was specific for cyst infection, but its sensitivity was only 1.1 %. A high intracystic SI on DWI showed a sensitivity of 86.4 %, but its specificity was lower at 33.3 %. Both the specificity and sensitivity of a fluid-fluid level or wall thickening were about 80 %. However, the specificity of these MRI features decreased as total liver and kidney volume (TLKV) increased, falling to 65.8 % in patients with organomegaly (TLKV > 8500 cm3). A cyst diameter > 5 cm was useful for detecting severely infected cysts that needed drainage, and specificity was increased by combining the other four MRI findings with a cyst diameter > 5 cm. CONCLUSIONS: MRI with DWI was useful for detecting severe cyst infection in ADPKD. While the specificity of MRI alone was not high enough in patients with organomegaly, combining the four MRI features with abdominal pain, sequential MRI changes, or cyst diameter > 5 cm improved detection of severely infected cysts in these patients.

Destructive Spondyloarthropathy in Patients on Long-Term Peritoneal Dialysis or Hemodialysis.

Destructive spondyloarthropathy (DSA) is the most serious spinal complication of dialysis-related amyloidosis in patients on long-term hemodialysis (HD), but we could not find any information about DSA in patients on peritoneal dialysis (PD) for over 10 years. We retrospectively evaluated factors contributing to DSA in HD and PD patients. Sixty-seven patients on dialysis for 10 to 19 years were compared between a PD group (n = 23) or a HD group (n = 44). In the PD group, nine patients (39%) developed DSA. The mean age of DSA patients was significantly higher than that of non-DSA patients (66.2 ± 10.0 vs. 51.0 ± 12.8 years, P = 0.03). The frequency of cervical spine DSA did not show any difference between the PD and HD groups, but the frequency of lumbar spine DSA showed a significant difference (22% vs. 5%, P = 0.04). The serum beta-2 microglobulin (B2MG) level was significantly higher in PD patients than in HD patients (38.4 mg/L vs. 27.4 mg/L, P = 0.0025). Mechanical stress such as elevation of the intra-abdominal pressure due to infusion of PD fluid (1500 mL to 2000 mL) for over 10 years might contribute to lumbar DSA in patients on long-term PD.

Presence of thoracic duct abnormalities in patients with primary lymphoedema of the extremities.

OBJECTIVES: Primary lymphoedema is said to be caused by lymph duct malformations, lymphatic hypoplasia or lymphatic agenesis, but no definite treatment has been established. In this study, we used magnetic resonance thoracic ductography (MRTD) to assess the morphology of the thoracic duct in patients with primary lymphoedema. METHODS: The study was conducted on nine patients with primary lymphoedema who were hospitalised at the Department of Plastic and Reconstructive Surgery (University of Tokyo Hospital) from September 2007 through April 2011. RESULTS: The patients consisted of five men and four women, aged 20-54 years (mean age: 31.1 years). Five of them were in early-onset group and the rest were in late-onset group. In the 6 months prior to the onset of oedema, three of the four patients in the late-onset group had episodes of trauma near the areas which would later be affected by lymphoedema. MRTD showed no clear image of the thoracic duct in four of five patients in the early-onset group. CONCLUSIONS: MRTD assessment of patients diagnosed as 'primary lymphoedema' indicates that the pathogenetic mechanisms seen in late-onset patients are completely different from those found in early-onset patients, and may be classified as 'traumatic lymphoedema.'

Clinical features of cyst infection and hemorrhage in ADPKD: new diagnostic criteria.

BACKGROUND AND OBJECTIVES: Cyst infection and cyst hemorrhage are frequent and serious complications of autosomal dominant polycystic kidney disease (ADPKD), often being difficult to diagnose and treat. The first objective of this study is to clarify the clinical features of ADPKD patients with cyst hemorrhage or infection. The second objective is to establish diagnostic criteria for ADPKD patients with cyst infection or cyst hemorrhage. PATIENTS AND METHODS: Patients with definite cyst infection or hemorrhage were enrolled from among the ADPKD patients referred to us between January 2004 and October 2011. We investigated their symptoms, laboratory data, and the computed tomography (CT)/magnetic resonance imaging (MRI) features of infected cysts (before and after onset), normal cysts, and cysts with hemorrhage. RESULTS: There were 24 patients with cyst infection (36 infected cysts) and 12 patients with acute cyst hemorrhage (13 bleeding cysts). White blood cell (WBC) count >10,000/µl, serum C-reactive protein (CRP) >15.0 mg/dl, and body temperature >38 °C strongly suggested cyst infection. All of the cysts with hemorrhage contained a high-density mass-like area or showed overall high density on CT, and all patients with cyst hemorrhage had abdominal pain or gross hematuria. On the other hand, infected cysts showed an increase of intensity on MRI [diffusion-weighted imaging (DWI)], while a fluid-fluid level, wall thickening, and gas were also evidence of infection. Abdominal pain and/or sequential changes on MRI after onset of symptoms were useful for localizing infected cysts. CONCLUSION: Acute cyst hemorrhage and infection can be identified from symptoms, laboratory data, and CT/MRI findings.

Using multidetector row computed tomography to evaluate baggy eyelid.

BACKGROUND: Baggy eyelids, formed by intraorbital fat herniation in the lower eyelids, are a sign of aging observed in the midface. This study aimed to identify the cause of baggy eyelids by evaluating the relationship between orbicularis oculi muscle thickness, orbital fat prolapse length, and age using multidetector row computed tomography (MDCT). METHODS: The 34 patients in the study ranged in age from 20 to 79 years. The patients were divided into three age groups: 20-29 years, 30-54 years, and 55-79 years. Orbicularis oculi muscle thickness and orbital fat prolapse length were measured using reconstructed computed tomography (CT) images. RESULTS: The orbicularis oculi muscle was found to be significantly thinner in the oldest group. Likewise, orbital fat prolapse was found to be significantly more prominent in the oldest group. A strong and significant negative correlation was found between orbicularis oculi muscle thickness and orbital fat prolapse length (r = -0.78; P < 0.001) and between orbicularis oculi muscle thickness and age (r = -0.77; P < 0.001). A strong and significant positive correlation was found between orbital fat prolapse length and age (r = 0.78; P < 0.001). CONCLUSIONS: The use of MDCT provides insight into the detailed changes associated with aging that take place within the lower eyelids. This study objectively demonstrated that the major factors associated with baggy eyelids include orbicularis oculi muscle thickness, orbital fat prolapse length, and age. Decreased orbicularis oculi muscle thickness leads to the orbital fat prolapse.

Assessment of configuration of thoracic duct using magnetic resonance thoracic ductography in idiopathic lymphedema.

The structure and the function of the peripheral lymph channels have been investigated, but the thoracic duct has not. This study used magnetic resonance thoracic ductography for 2 patients with idiopathic lymphedema to evaluate the configuration of the thoracic duct in these patients. Anomalies of the thoracic duct were detected in both cases. This result suggests that deformity of the thoracic duct is one of the causes of idiopathic lymphedema. Characterization of the etiology could lead to a breakthrough in resolving the occurrence of idiopathic lymphedema and developing a treatment procedure for it. In addition, visualization of the thoracic duct may assist in selecting the optimal therapy for each idiopathic lymphedema patient.

[Effects of computed tomography contrast medium factors on contrast enhancement].

The various nonionic iodinated contrast media used in contrast computed tomography (CT) studies differ in terms of their composition, characteristics, and iodine concentration (mgI/ml), as well as the volume injected (ml). Compared with ionic iodinated contrast media, nonionic iodinated contrast media are low-osmolar agents, with different agents having different osmotic pressures. Using a custom-made phantom incorporating a semipermeable membrane, the osmotic flow rate (HU/s) could easily be measured based on the observed increase in CT numbers, and the relationship between the osmotic pressure and the osmotic flow rate could be obtained (r(2)=0.84). In addition, taking the effects of patient size into consideration, the levels of contrast enhancement in the abdominal aorta (AA) and inferior vena cava (IVC) were compared among four types of CT contrast medium. The results showed differences in contrast enhancement in the IVC during the equilibrium phase depending on the type of contrast medium used. It was found that the factors responsible for the differences observed in enhancement in the IVC were the osmotic flow rate and the volume of the blood flow pathways in the circulatory system. It is therefore considered that the reproducibility of contrast enhancement is likely to be reduced in the examination of parenchymal organs, in which scanning must be performed during the equilibrium phase, even if the amount of iodine injected per unit body weight (mgI/kg) is maintained at a specified level.

Depiction of the thoracic duct by magnetic resonance imaging: comparison between magnetic resonance imaging and the anatomical literature.

PURPOSE: The aim of this study was to compare thoracic duct (TD) configuration depicted by magnetic resonance imaging (MRI) with TD configuration described in the anatomical literature. MATERIALS AND METHODS: MRI Scans were acquired with a three-dimensional T2-weighted turbo spin echo (TSE) MRI with a two-dimensional prospective acquisition correction (PACE) technique in 63 patients. We found with MRI that TD displacement occurred more on the left side than that reported in the anatomical literature, and this tendency was more marked in elderly patients. In patients with marked leftward TD displacement, the TD configuration on MRI was compared to the descending aortic configuration on chest radiography. The degree of correspondence between the MRI findings and the anatomical literature was assessed by a χ(2) goodness-of-fit test, and P < 0.05 indicated a significant difference. The degree of similarity was determined between TD configuration and aortic configuration by Kendall's coefficient of concordance (W). RESULTS: On MRI scans the TD was often located to the left of the mid-vertebral line compared to the location reported in the anatomical literature (P < 0.001). Nine patients had marked leftward TD displacement, a configuration similar to that of the descending aorta (W = 1); however, no association with age was established. CONCLUSION: The TD configuration depicted by MRI differed from that described in the anatomical literature.

A case of a fibroadenoma coexisting with an invasive lobular carcinoma in the breast.

A case of a fibroadenoma coexisting with an invasive lobular carcinoma of the breast in a 60-year-old female is presented, and its pathological features are correlated with high-resolution magnetic resonance imaging (HR-MRI) and other imaging findings. The patient presented with the chief complaint of having a palpable mass in her right breast for 3 months. Mammography revealed a lobular mass with a micro-lobulated margin, which suggested a malignant nature; however, it included coarse calcifications. Sonographic imaging and HR-MRI findings were compatible with malignant tumor. Cytology was performed, and the results indicated an invasive carcinoma. Breast-conserving surgery was performed as a curative operation. The pathological features revealed a fibroadenoma coexisting with an invasive lobular carcinoma. This case suggests that radiologists should always pay attention to the associated malignant imaging characteristics, such as the shape and border of the mass, whenever a mass demonstrates benign-like calcifications.