Radiological Case: Incidental Atypical Sclerosing Papilloma Within a Radial Scar on Digital Breast Tomosynthesis

Susan N. Samreth, MS; Kimberly A. Fitzpatrick, MD; Lauren G. Lebeau, MD; Wendy S. MacKerricher, MD; Marisa H. Borders, MD

Disclosures

Appl Radiol. 2017;46(7):44-47. 

In This Article

Imaging Findings

Digital breast tomosynthesis (DBT) images of both breasts were performed. Mammography and ultrasound of the right breast revealed a heterogeneous circumscribed solid mass with moderate associated color flow measuring 4.8 cm (Figure 1). Incidentally, in the left breast, a prominent area of architectural distortion was identified on mammography, best seen medially on the craniocaudad view (Figure 2). Additional 2-D spot compression views demonstrated persistent architectural distortion in the lower inner quadrant of the left breast (Figure 3). Targeted left breast ultrasound revealed focal fibrocystic changes on the left (Figure 4). Bilateral contrast-enhanced breast MRI showed a large homogeneously enhancing mass in the right breast and a highly suspicious 2.2 cm irregular mass with spiculated margins and associated washout in the lower inner quadrant of the left breast (Figure 5). Surgical excisional biopsy confirmed a benign fibroadenoma in the right breast, and an atypical sclerosing papilloma in the setting of a radial scar/complex sclerosing lesion in the left breast.

Figure 1.

Right breast ultrasound image in the radial plane reveals a 4.8 cm circumscribed heterogeneous solid mass (biopsy-proven fibroadenoma).

Figure 2.

CC (A) and MLO (B) digital breast tomosynthesis views of the left breast demonstrate an incidental prominent area of architectural distortion in the lower inner quadrant.

Figure 3.

CC (A) and MLO (B) 2-D spot compression views of the lower inner quadrant of the left breast demonstrate persistent architectural distortion.

Figure 4.

Left breast ultrasound in the transverse plane reveals only benign fibrocystic changes.

Figure 5.

Maximum intensity projection (MIP) image (A) and high-resolution contrast-enhanced T1 fat-saturated MRI image in the axial plane (B) demonstrate a large homogeneously enhancing mass on the right and a highly suspicious 2.2 cm irregular mass with spiculated margins and associated washout in the lower inner quadrant of the left breast.

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