Benign Breast Lesions That Mimic Cancer: Determining Radiologic-Pathologic Concordance

Julia Mario, BA; Shambhavi Venkataraman, MD; Vandana Dialani, MD; Priscilla J. Slanetz MD, MPH

Disclosures

Appl Radiol. 2015;44(9):28-32. 

In This Article

Other Benign Conditions

Other benign entities that mimic breast cancer include Cooper's ligament, sarcoidosis and breast infarct. Cooper's ligaments can demonstrate shadowing on ultrasound (Figure 6A), but imaging in the orthogonal plane will demonstrate no persistent abnormality, thus confirming a normal anatomic structure.

Figure 6.

Miscellaneous conditions. (A) 60-year-old woman with focal pain in her right upper breast. Mammography (not shown) revealed dense breast tissues. Ultrasound showed a 0.5 cm irregular hypoechoic lesion with some internal vascularity, which was less apparent in the sagittal plane. Biopsy was performed due to indeterminate appearance and confirmed a Cooper's ligament. (B) 64-year-old woman with long history of sarcoidosis presented for routine screening. Mammography (not shown) revealed a developing asymmetry in the medial upper left breast. Ultrasound showed an irregular hypoechoic mass (arrows). Biopsy confirmed sarcoidosis involving the breast. C) 89-year-old woman with long-standing atrial fibrillation treated with warfarin anticoagulation presented for screening mammography. Mammogram showed a focal group of heterogeneous but predominantly punctuate calcifications concerning for DCIS (circle). Stereotactic core biopsy confirmed atrophic breast tissue with infarct.

Sarcoidosis is a benign granulomatous systemic condition of unknown etiology that can secondarily affect the breast in <1% of cases[46] in patients with active systemic disease. Most commonly, it presents as bilateral axillary and/or intramammary lymphadenopathy, best appreciated as dense enlarged nodes on mammography or as abnormally enlarged nodes with thickened cortices on ultrasound. In rare cases, sarcoidosis can present as an irregular or spiculated breast mass or as a developing asymmetry on mammography, or as an irregular hypoechoic mass on ultrasound (Figure 6B). On MRI, a suspiciously enhancing irregular mass with progressive to washout kinetics has been reported.[47] In almost all cases, biopsy to exclude malignancy is indicated.

Breast infarct is a rare condition that typically presents as a painful palpable lump but also rarely may present as grouped calcifications on mammography (Figure 6C).[48] It is associated with pregnancy and lactation and can be seen in patients taking systemic anticoagulation such as warfarin. Biopsy often is performed to exclude malignancy.

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