BREASTBREAST
NORMAL ANATOMYNORMAL ANATOMY
The breast consist of three types of tissue:
the skin
subcuteneous adepose tissue and
the functional glandular tissue.
The breast consist of three types of tissue:
the skin
subcuteneous adepose tissue and
the functional glandular tissue.
Centrally, there is the nipple-areolar complex. Collecting duct open onto the tip of the nipple. Centrally, there is the nipple-areolar complex. Collecting duct open onto the tip of the nipple.
There are sebaceous glands within the nipple-areolar complex called
montomery’s gland. Small raised nodular structures called
montomery’s tubercle.
There are sebaceous glands within the nipple-areolar complex called
montomery’s gland. Small raised nodular structures called
montomery’s tubercle.
Deep to nipple-areolar complex, breast is divided into15-25 lobes,each
consisting of a branching duct system leading from the collecting
ducts to the terminal duct lobular units (TDLU), the site of milk
production in lactating breast.
Each duct drains a lobe made up of 20-40 lobules.
Deep to nipple-areolar complex, breast is divided into15-25 lobes,each
consisting of a branching duct system leading from the collecting
ducts to the terminal duct lobular units (TDLU), the site of milk
production in lactating breast.
Each duct drains a lobe made up of 20-40 lobules.
The breast lies on the chest wall on the deep pectoral fascia.
The superficial pectoral fascia envelops the breast.
Suspensory ligaments – Cooper’s ligament – connect the two layers, providing a degree of support to the breast and giving the breast its shape.
The breast lies on the chest wall on the deep pectoral fascia.
The superficial pectoral fascia envelops the breast.
Suspensory ligaments – Cooper’s ligament – connect the two layers, providing a degree of support to the breast and giving the breast its shape.
The number of lobules per lobe varies according to age,
lactation,parity and hormonal status.
At the end of reproductive life there is an increase in amount of
adepose tissue and the main duct system is preserved, considerable
loss of lobular unit.
The number of lobules per lobe varies according to age,
lactation,parity and hormonal status.
At the end of reproductive life there is an increase in amount of
adepose tissue and the main duct system is preserved, considerable
loss of lobular unit.
1. Muscle of the chest
wall.
2. Pectoralis muscles,
these support the
breast.
3. Lobules, the
mammary glands
that produce the
milk.
4. Nipple.
5. Areola.
6. Lactiferous duct,
carry the milk from
the glands to the
nipple.
7. Mammary fat.
8. Chest.
1. Muscle of the chest
wall.
2. Pectoralis muscles,
these support the
breast.
3. Lobules, the
mammary glands
that produce the
milk.
4. Nipple.
5. Areola.
6. Lactiferous duct,
carry the milk from
the glands to the
nipple.
7. Mammary fat.
8. Chest.
BREAST ULTRASOUND TECHNIQUEBREAST ULTRASOUND TECHNIQUE
Dynamically focused phased array, linear array and annular
transducers of 7-10 MHz should be used.
Dynamically focused phased array, linear array and annular
transducers of 7-10 MHz should be used.
The patient is examined in supine oblique position.The patient is examined in supine oblique position.
The side being examined is raised and the arm placed above the head to ensure that the breast tissue is evenly distributed over the chest wall.
The side being examined is raised and the arm placed above the head to ensure that the breast tissue is evenly distributed over the chest wall.
Scanning in the radial and antiradial planes are of value in demonstrating ductal abnormality.Scanning in the radial and antiradial planes are of value in demonstrating ductal abnormality.
INDICATIONS INDICATIONS
Symptomatic breast lumps in women aged less than 35yrs.Symptomatic breast lumps in women aged less than 35yrs.
Breast lump developing during pregnancy and lactationBreast lump developing during pregnancy and lactation
Assessment of mammographic abnormality Assessment of mammographic abnormality
Breast inflammationBreast inflammation
Breast lump in male Breast lump in male
Guidance of needle biopsy or localizationGuidance of needle biopsy or localization
Follow-up of breast cancer treated with adjuvant chemotherapyFollow-up of breast cancer treated with adjuvant chemotherapy
Clinical mass with negative mammogramClinical mass with negative mammogram
The augmented breastThe augmented breast
Sonographic AnatomySonographic Anatomy
The anatomic components of the breast and sorrounding structures
(skin, ducts,adepose tissue, parenchyma, nipple, blood vessels,
retrommary muscles and ribs) have characteristic sonographic features.
The skin complexThe skin complex
Is seen as two thin, echogenic lines demarcating a narrow hypoechoic
band, the dermis.
The normal skin measures up to 0.2 cm in thickness , may be thicker in
the lower breast near the inframammary fold.
Is seen as two thin, echogenic lines demarcating a narrow hypoechoic
band, the dermis.
The normal skin measures up to 0.2 cm in thickness , may be thicker in
the lower breast near the inframammary fold.
Fat lobulesFat lobules
Oval in one plane of view and elongated in the orthogonal plane.
They are hypoechoic relative to the sorrounding glandular tissue and
may have a central echogenic focus of connective tissue.
The subcuteneous fat lobules and those within the breast are usually
larger than fat lobules located in the pectoral area.
Oval in one plane of view and elongated in the orthogonal plane.
They are hypoechoic relative to the sorrounding glandular tissue and
may have a central echogenic focus of connective tissue.
The subcuteneous fat lobules and those within the breast are usually
larger than fat lobules located in the pectoral area.
Breast parenchymaBreast parenchyma
Appears homogeneously echogenic as compared with fat lobules but
may have hypoechoic zones caused by fatty tissue.
Fibroglandular tissue appears echogenic.
Found in pt of all ages, but characteristic of the breasts of very young,
excessive homogenously echogenic tissue.
Appears homogeneously echogenic as compared with fat lobules but
may have hypoechoic zones caused by fatty tissue.
Fibroglandular tissue appears echogenic.
Found in pt of all ages, but characteristic of the breasts of very young,
excessive homogenously echogenic tissue.
Cooper’s ligamentCooper’s ligament
Appears as thin, echogenic arcs. Appears as thin, echogenic arcs.
Terminal duct lobular units( TDLU)Terminal duct lobular units( TDLU)
Many benign ( cysts, adenosis, fibroadenoma) and malignant process
arises from it.
The TDLU may enlarge or involute, reflecting age and physiologic
differences and proliferate in pregnancy.
Hyperplastic TDLU are seen on USG image as hyechoic areas.
Many benign ( cysts, adenosis, fibroadenoma) and malignant process
arises from it.
The TDLU may enlarge or involute, reflecting age and physiologic
differences and proliferate in pregnancy.
Hyperplastic TDLU are seen on USG image as hyechoic areas.
The mammary ductsThe mammary ducts
Visible as tubular structures measures about 0.1cm to 0.8cm in diameter.Visible as tubular structures measures about 0.1cm to 0.8cm in diameter.
The mammary ductsThe mammary ducts
Medium level echogenicity and attenuates sound, resulting posterior
acoustic shadows.
Scanning obliquely behind the nipple or using an offset pad will allow
the area posterior to the nipple to be visualized.
Normal nipple sometimes appear as a well-defined hypoechoic oval area
resembling a superficial adenoma if imaged from an oblique angle.
Medium level echogenicity and attenuates sound, resulting posterior
acoustic shadows.
Scanning obliquely behind the nipple or using an offset pad will allow
the area posterior to the nipple to be visualized.
Normal nipple sometimes appear as a well-defined hypoechoic oval area
resembling a superficial adenoma if imaged from an oblique angle.
Visible as thin lines, usually not seen.
The superficial layer seen below the dermis, the deeper layer lies over
the retromammary fat and pectoralis muscle.
Visible as thin lines, usually not seen.
The superficial layer seen below the dermis, the deeper layer lies over
the retromammary fat and pectoralis muscle.
The fascial envelopeThe fascial envelope
Visualization of the pectoralis muscle assures that the breast
parenchyma has been adequately penetrated at that site.
Visualization of the pectoralis muscle assures that the breast
parenchyma has been adequately penetrated at that site.
Pectoralis musclePectoralis muscle
The ribsThe ribs
Oval, hypoechoic, periodic structures behind the pectoralis muscles.
They attenuate sound, causing a posterior acoustic shadow.
Oval, hypoechoic, periodic structures behind the pectoralis muscles.
They attenuate sound, causing a posterior acoustic shadow.
An ultrasonogram of a normal breast. F, subcutaneous fat; FG, fibroglandular tissue with intervening fatty tissue; P, pectoralis muscle; S, skin. The hypoechoic region beneath the pectoralis muscle represents a rib (arrow).
An ultrasonogram of a normal breast. F, subcutaneous fat; FG, fibroglandular tissue with intervening fatty tissue; P, pectoralis muscle; S, skin. The hypoechoic region beneath the pectoralis muscle represents a rib (arrow).
Breast PathologyBreast Pathology
Cysts Cysts
Benign mass lesionBenign mass lesion
Fibroadenoma and related conditionsFibroadenoma and related conditions
Papilloma Papilloma
Hamartoma Hamartoma
Lipoma Lipoma
Malignant mass lesionMalignant mass lesion
Carcinoma of breastCarcinoma of breast
Inflammations Inflammations
Acute mastitis Acute mastitis
Breast abscess Breast abscess
Mammary duct ectasia
Mammary duct ectasia
Tramatic fat necrosis
Tramatic fat necrosis
Fibrocystic diseaseFibrocystic disease
Simple fibrocystic changes
Simple fibrocystic changes
Epithelial hyperplasia
Epithelial hyperplasia
Simple Breast Cyst Simple Breast Cyst
Simple Cyst
anechoic
well-marginated
round, ovoid, or lobulated
solitary or multiple
well-defined posterior wall
acoustic enhancement
Simple Cyst
anechoic
well-marginated
round, ovoid, or lobulated
solitary or multiple
well-defined posterior wall
acoustic enhancement
Breast cyst Breast cyst
Ultrasound Demonstrates Cysts in BreastUltrasound Demonstrates Cysts in Breast
Complex Cysts
These cysts may contain internal echoes, as a result of hemorrhage or infection, and may demonstrate wall thickness. These cysts may contain internal echoes, as a result of hemorrhage or infection, and may demonstrate wall thickness.
Ultrasound image showing adjacent breast masses:one a simple cyst, the other debris filled. Ultrasound image showing adjacent breast masses:one a simple cyst, the other debris filled.
A complex cyst shows low-level internal echoes/ fluid-debris level. These internal echoes may be caused by floating cholesteral crystals, pus, blood, or milk of calcium crystals.
A complex cyst shows low-level internal echoes/ fluid-debris level. These internal echoes may be caused by floating cholesteral crystals, pus, blood, or milk of calcium crystals.
Figures 5 and 6 demonstrate complex cystic areas with an internal soft tissue component. Biopsy was performed on both of these lesions, confirming the diagnosis of benign intracystic papilloma. These lesions occur from a growth within a duct that eventually results in ductal obstruction and cyst formation.
Figures 5 and 6 demonstrate complex cystic areas with an internal soft tissue component. Biopsy was performed on both of these lesions, confirming the diagnosis of benign intracystic papilloma. These lesions occur from a growth within a duct that eventually results in ductal obstruction and cyst formation.
Ultrasonogram demonstrates 2 ovoid, smooth, thin-walled, anechoic masses with acoustic enhancement. The larger is anechoic, compatible with a simple cyst (see arrow). The smaller contains some internal echoes, although it also was shown to represent a cyst.
Ultrasonogram demonstrates 2 ovoid, smooth, thin-walled, anechoic masses with acoustic enhancement. The larger is anechoic, compatible with a simple cyst (see arrow). The smaller contains some internal echoes, although it also was shown to represent a cyst.
Fibroadenoma. Fibroadenoma.
A fibroadenoma is the most common benign tumor in women of child-
bearing age.
The mass presents as a firm, smooth, oval shaped, well-marginated
(sometimes lobulated), freely movable mass.
It is rarely tender or painful. The size is under 5cm, the number is
multiple in 10-20% and bilateral in 4%.
Calcifications may occur.
A fibroadenoma is the most common benign tumor in women of child-
bearing age.
The mass presents as a firm, smooth, oval shaped, well-marginated
(sometimes lobulated), freely movable mass.
It is rarely tender or painful. The size is under 5cm, the number is
multiple in 10-20% and bilateral in 4%.
Calcifications may occur.
On ultrasoundOn ultrasound
The texture is usually homogenous and hypoechoic with low-level
echoes.
In a small number of patients, the mass may appear complex,
hyperechoic, or isoechoic.
The solid nature of the mass prevents acoustic transmission.
There may be few well-circumscribed lobulations.
Growth in the horizontal plane may be greater than that in the
vertical
The texture is usually homogenous and hypoechoic with low-level
echoes.
In a small number of patients, the mass may appear complex,
hyperechoic, or isoechoic.
The solid nature of the mass prevents acoustic transmission.
There may be few well-circumscribed lobulations.
Growth in the horizontal plane may be greater than that in the
vertical
Fibroadenoma. Fibroadenoma.
Breast Fibroadenomas Breast Fibroadenomas
Breast Abscess Breast Abscess
When viewed by ultrasound,
abscesses commonly have
thick walls and are oval or
irregular in shape.
They typically contain
cystic and solid
components, resulting in a
complex appearance, and
demonstrate acoustic
enhancement
When viewed by ultrasound,
abscesses commonly have
thick walls and are oval or
irregular in shape.
They typically contain
cystic and solid
components, resulting in a
complex appearance, and
demonstrate acoustic
enhancement
Breast Abscess: Breast Abscess:
Ultrasound images of the breast
reveal a rounded, almost anechoic
lesion with posterior acoustic
enhancement.
The lesion measures 2 cms. and
has irregular but well defined
walls.
No internal septae are present.
Color Doppler images suggest
some increase in vascularity along
the rim of the lesion.
These ultrasound findings
suggest an abscess of the breast.
Ultrasound images of the breast
reveal a rounded, almost anechoic
lesion with posterior acoustic
enhancement.
The lesion measures 2 cms. and
has irregular but well defined
walls.
No internal septae are present.
Color Doppler images suggest
some increase in vascularity along
the rim of the lesion.
These ultrasound findings
suggest an abscess of the breast.
Chronic Abscess Of The Breast. Chronic Abscess Of The Breast.
Clinical symptoms include
fever, pain, tenderness to
touch, increased white
blood count.
The most common location
is in the central to
subareolar area.
An abscess may range
from somewhat ill-defined
to well-defined, anechoic to
low-level echoes, with
posterior enhancement.
Clinical symptoms include
fever, pain, tenderness to
touch, increased white
blood count.
The most common location
is in the central to
subareolar area.
An abscess may range
from somewhat ill-defined
to well-defined, anechoic to
low-level echoes, with
posterior enhancement.
Sebaceous Cyst Sebaceous Cyst
Sebaceous cysts are formed as a result of obstructed
sebaceous glands or hair follicles.
These cysts contain an oily substance, and are therefore
often characterized by internal echoes that may be seen
on ultrasound.
They are typically located at the inferior and medial breast
margins, or near the axilla.
Sebaceous cysts are formed as a result of obstructed
sebaceous glands or hair follicles.
These cysts contain an oily substance, and are therefore
often characterized by internal echoes that may be seen
on ultrasound.
They are typically located at the inferior and medial breast
margins, or near the axilla.
Mastitis During Breastfeeding Mastitis During Breastfeeding
Edema affects all layers of the breast parenchyma in mastitis.
The skin and subcutaneous fat become thickened and hyperechoic.
In addition, the Cooper's ligaments may become more hypoechoic.
Hyperemia may also be demonstrated with color Doppler.
Edema affects all layers of the breast parenchyma in mastitis.
The skin and subcutaneous fat become thickened and hyperechoic.
In addition, the Cooper's ligaments may become more hypoechoic.
Hyperemia may also be demonstrated with color Doppler.
Mastitis is inflammation of the breast. It can be associated with
lactation (puerperal) or other conditions, such as an infected cyst
(nonpuerperal)
Mastitis is inflammation of the breast. It can be associated with
lactation (puerperal) or other conditions, such as an infected cyst
(nonpuerperal)
Ultrasound images of lactating breast: Ultrasound images of lactating breast:
Ultrasound image shows prominent
and dilated mammary ducts in the
lactating breast.
The ducts are seen as tubular
hypoechoic structures, which
widen as they approach the nipple.
Sometimes, it may be possible to
see fat drops within the milk
secretions in the ducts. These
appear as mildly echogenic debris
within the ducts.
Ultrasound image shows prominent
and dilated mammary ducts in the
lactating breast.
The ducts are seen as tubular
hypoechoic structures, which
widen as they approach the nipple.
Sometimes, it may be possible to
see fat drops within the milk
secretions in the ducts. These
appear as mildly echogenic debris
within the ducts.
On ultrasound, it appears as hypoechoic to anechoic with ill-
defined margins. Acoustic shadow may or may not be present.
Characteristics of fat necrosis on ultrasound may vary
depending on the lesion; fat necrosis may look like a simple
cyst or anechoic mass with solid components.
On ultrasound, it appears as hypoechoic to anechoic with ill-
defined margins. Acoustic shadow may or may not be present.
Characteristics of fat necrosis on ultrasound may vary
depending on the lesion; fat necrosis may look like a simple
cyst or anechoic mass with solid components.
Fat necrosisFat necrosis
Fat necrosis occurs in a very small percentage of breast
biopsies, post-surgery, or after radiation treatments.
It may be found anywhere however is more common in the
areolar region or near the biopsy site.
The appearance is a firm, slightly fixed mass with skin
retraction in half of the cases.
The mass may show calcifications.
Fat necrosis occurs in a very small percentage of breast
biopsies, post-surgery, or after radiation treatments.
It may be found anywhere however is more common in the
areolar region or near the biopsy site.
The appearance is a firm, slightly fixed mass with skin
retraction in half of the cases.
The mass may show calcifications.
Several lucent nodules are present in the upper outer right breast, with surrounding density, consistent with fat necrosis.
Several lucent nodules are present in the upper outer right breast, with surrounding density, consistent with fat necrosis.
Oil cyst of breast: Oil cyst of breast:
The breast in this patient
showed multiple cystic
lesions on sonography.
Remarkably, there is
acoustic shadowing
posterior to the cyst. Clear
fluid contents are seen
within the cystic lesions.
The breast in this patient
showed multiple cystic
lesions on sonography.
Remarkably, there is
acoustic shadowing
posterior to the cyst. Clear
fluid contents are seen
within the cystic lesions. Calcific oil cysts of the breast Calcific oil cysts of the breast
Oil cysts are produced due to fat necrosis with liquefaction and subsequent cyst formation, usually following trauma. Oil cysts are produced due to fat necrosis with liquefaction and subsequent cyst formation, usually following trauma.
This condition
includes hyperplasia
and hypertrophy of
the glandular
elements within the
breast.
The lobules show an
increase in size and
on ultrasound appear
as isoechoic to mildly
isochoic as compared
with fat.
This condition
includes hyperplasia
and hypertrophy of
the glandular
elements within the
breast.
The lobules show an
increase in size and
on ultrasound appear
as isoechoic to mildly
isochoic as compared
with fat.
Adenosis.Adenosis.
This condition is found in 72% of the screening population over
55 years of age.
The cause is an exaggeration of normal cyclical proliferation and
involution of the breast with production and incomplete
absorption of fluid by apocrine cells.
Clinical symptoms include fullness, tenderness, and pain that
varies with the menstrual cycle.
There may be palpable nodules and thickening within the breast.
Fibrocystic ChangesFibrocystic Changes
The cystic changes
include round to ovid
cysts with smooth
margins. They may be
lobulated or
multilocular.
These changes are well
defined on ultrasound.
The cystic changes
include round to ovid
cysts with smooth
margins. They may be
lobulated or
multilocular.
These changes are well
defined on ultrasound.
Galactocele of breast: Galactocele of breast:
Hypoechoic (almost cystic) lesion with through transmission.
Color doppler images of the breast showed no signficant enhancement of vascularity.
Hypoechoic (almost cystic) lesion with through transmission.
Color doppler images of the breast showed no signficant enhancement of vascularity.
Galactocele with a fat-fluid level s/o galactocele. The echogenic material is seen to move with change in posture
Galactocele with a fat-fluid level s/o galactocele. The echogenic material is seen to move with change in posture
Hypoechoic
Irregularly marginated (especially anterior margin)
Heterogeneous internal echoes
Acoustic shadowing
Hypoechoic
Irregularly marginated (especially anterior margin)
Heterogeneous internal echoes
Acoustic shadowing
Carcinoma of breast: Carcinoma of breast:
Ultrasound Appearance Of Malignant Disease Of The BreastUltrasound Appearance Of Malignant Disease Of The Breast
Noninvasive Breast Cancer. This type of cancer accounts for
15% of all cancers. It occurs when there is a malignant
transformation of epithelial cells lining the mammary ducts and
lobules confined within the boundaries of the basement
membrane.
Noninvasive Breast Cancer
ductal carcinoma in situ,
lobular carcinoma in situ
intracystic papillary carcinoma in situ.
Noninvasive Breast Cancer. This type of cancer accounts for
15% of all cancers. It occurs when there is a malignant
transformation of epithelial cells lining the mammary ducts and
lobules confined within the boundaries of the basement
membrane.
Noninvasive Breast Cancer
ductal carcinoma in situ,
lobular carcinoma in situ
intracystic papillary carcinoma in situ.
TypesTypes
Invasive Breast Carcinoma. This type of malignancy accounts for
the majority of breast cancers in 85% of the population.
Invasive Breast Cancer
Infiltrating/invasive ductal carcinoma (65%)
Invasive lobular carcinoma (8-13%)
Tubular carcinoma (6-8%)
Medullary carcinoma (2%)
Mucinous carcnimoa (2%)
Papillary carcinoma (2-4%)
Invasive Breast Carcinoma. This type of malignancy accounts for
the majority of breast cancers in 85% of the population.
Invasive Breast Cancer
Infiltrating/invasive ductal carcinoma (65%)
Invasive lobular carcinoma (8-13%)
Tubular carcinoma (6-8%)
Medullary carcinoma (2%)
Mucinous carcnimoa (2%)
Papillary carcinoma (2-4%)
Invasive Ductal Carcinoma Invasive Ductal Carcinoma
Invasive ductal carcinoma is predominantly hypoechoic, but the mass is indistinctly separated from the echogenic halo (arrow) that surrounds it. The halo may or may not contain tumor cells, but two measurements, one of the hypoechoic area alone and a second, the diameter of the hypoechoic component plus the echogenic rim, could be reported.
This is the most common noninvasive carcinoma.
It occurs in postmenapausal women over 55 years old.
The mass may persist for years without a palpable abnormality.
Therefore, when the mass is noted, it is usually large enough to
feel by palpation; nipple discharge may be present as well as
microcalcifications.
This is the most common noninvasive carcinoma.
It occurs in postmenapausal women over 55 years old.
The mass may persist for years without a palpable abnormality.
Therefore, when the mass is noted, it is usually large enough to
feel by palpation; nipple discharge may be present as well as
microcalcifications.
Ductal carcinoma in situDuctal carcinoma in situ
This disease arises in the epithelium of the blunt ducts of the
mammary lobules.
It comprises about one fourth of the noninvasive cancers, with an
increased incidence during the reproductive years.
It may present as a noncalcified mass, or with calcifications and a
palpable mass.
It may also occur on the contralateral breast.
This disease arises in the epithelium of the blunt ducts of the
mammary lobules.
It comprises about one fourth of the noninvasive cancers, with an
increased incidence during the reproductive years.
It may present as a noncalcified mass, or with calcifications and a
palpable mass.
It may also occur on the contralateral breast.
Lobular carcinoma in situLobular carcinoma in situ
This cancer is rare and affects middle aged females with the
average age 51 years.
The mass is well circumscribed and freely moveable.
Bloody fluid is obtained with aspiration.
Ultrasound findings show a solid well-defined mass.
This cancer is rare and affects middle aged females with the
average age 51 years.
The mass is well circumscribed and freely moveable.
Bloody fluid is obtained with aspiration.
Ultrasound findings show a solid well-defined mass.
Intracystic papillary carcinoma in situ.Intracystic papillary carcinoma in situ.
This is the second most common type of breast cancer (30-50%).
At least 30-50% of patients will develop a second primary in the same
or opposite breast within 20 years.
It is the most frequently missed cancer as it is difficult to detect on
mammography and by clinical examination.
Clinical findings may show architectural distortion, thickening of
fibrous septa, spiculations, poorly defined borders,
microcalcifications, and skin/ nipple retraction.
This is the second most common type of breast cancer (30-50%).
At least 30-50% of patients will develop a second primary in the same
or opposite breast within 20 years.
It is the most frequently missed cancer as it is difficult to detect on
mammography and by clinical examination.
Clinical findings may show architectural distortion, thickening of
fibrous septa, spiculations, poorly defined borders,
microcalcifications, and skin/ nipple retraction.
Invasive lobular carcinomaInvasive lobular carcinoma
This cancer is a well differentiated form of ductal carcinoma
occurring in the middle aged female with a positive family history.
It is associated with lobular carcinoma in situ in 40% of patients.
This cancer is a well differentiated form of ductal carcinoma
occurring in the middle aged female with a positive family history.
It is associated with lobular carcinoma in situ in 40% of patients.
This is the fastest growing breast carcinoma seen in the middle aged
female.
The mass is well circumscribed with a nodular architecture and
lobulated contour.
In larger tumors, a central necrosis may be seen.
On ultrasound the mass appears hypoechoic with some through
transmission if there is central cystic necrosis and indeterminate
borders.
This is the fastest growing breast carcinoma seen in the middle aged
female.
The mass is well circumscribed with a nodular architecture and
lobulated contour.
In larger tumors, a central necrosis may be seen.
On ultrasound the mass appears hypoechoic with some through
transmission if there is central cystic necrosis and indeterminate
borders.
Tubular carcinoma.Tubular carcinoma.
Medullary carcinoma.Medullary carcinoma.
This rare tumor appears in older women and shows a slow growth
pattern.
This rare tumor appears in older women and shows a slow growth
pattern.
Mucinous colloid carcinomaMucinous colloid carcinoma
Most women present with a palpable mass with a quarter showing
nipple discharge.
The mass is usually solitary with well-circumscribed borders.
More than half will show microcalcifications.
There is a 90% five year survival rate after a mastectomy
Most women present with a palpable mass with a quarter showing
nipple discharge.
The mass is usually solitary with well-circumscribed borders.
More than half will show microcalcifications.
There is a 90% five year survival rate after a mastectomy
Papillary carcinomaPapillary carcinoma
Carcinoma of breast: Carcinoma of breast:
These ultrasound images reveal a hypoechoic, poorly defined,
irregular mass in the breast. There is also evidence of acoustic
shadowing posteriorly. These findings on sonography suggest
malignant mass of the breast.
These ultrasound images reveal a hypoechoic, poorly defined,
irregular mass in the breast. There is also evidence of acoustic
shadowing posteriorly. These findings on sonography suggest
malignant mass of the breast.
Left breast ultrasound shows a rounded, hypoechoic solid lesion with the borders ill-defined in part. Left breast ultrasound shows a rounded, hypoechoic solid lesion with the borders ill-defined in part.
Carcinoma of breast: Carcinoma of breast:
Carcinoma of breast: Carcinoma of breast:
Left axilla. Left axilla. Breast ultrasound Breast ultrasound
Gynecomastia in a Young Male Gynecomastia in a Young Male
Gynecomastia is a condition
that results in male breast
enlargement due to an
abnormal proliferation of
ductal tissue, glandular tissue,
and stroma.
Increased subcutaneous fat
may also be noted.
Gynecomastia is a condition
that results in male breast
enlargement due to an
abnormal proliferation of
ductal tissue, glandular tissue,
and stroma.
Increased subcutaneous fat
may also be noted.
Ultrasonogram of late gynecomastia.
Development of fibrosis in late
gynecomastia leads to an increase in
echogenicity of the breast parenchyma
Ultrasonogram of late gynecomastia.
Development of fibrosis in late
gynecomastia leads to an increase in
echogenicity of the breast parenchyma
Breast ultrasound showed in the right retroareolar region, a solid mass of 3 × 1 cm with homogeneous echostructure and well-defined margins.
Breast ultrasound showed in the right retroareolar region, a solid mass of 3 × 1 cm with homogeneous echostructure and well-defined margins.
Solitary fibrous tumor of the male breast Solitary fibrous tumor of the male breast
This lesion has a variable
appearance; it may be elongated
and filled with fluid.
Old cellular debris may appear as
hypoechoic on ultrasound,
however the "tubular"appearance is
more typical.
This lesion has a variable
appearance; it may be elongated
and filled with fluid.
Old cellular debris may appear as
hypoechoic on ultrasound,
however the "tubular"appearance is
more typical.
Duct EctasiaDuct Ectasia
This lesion is rarely seen; the mean age is 45 years.
The mass is soft and nonpalpable in 60% of patients.
It appears in the retroareolar and upper outer quadrant in 65% of
patients.
A hamartoma is round or ovoid, well-circumscribed, and less
than 3 cm in size. It may contain calcifications.
This lesion is rarely seen; the mean age is 45 years.
The mass is soft and nonpalpable in 60% of patients.
It appears in the retroareolar and upper outer quadrant in 65% of
patients.
A hamartoma is round or ovoid, well-circumscribed, and less
than 3 cm in size. It may contain calcifications.
HamartomaHamartoma
Ultrasound findings have shown a harmartoma to contain
fibrous elements that may be specular in their reflections with
hypoechoic texture. The mass is encapsulated and distinct from
surround tissue.
Ultrasound findings have shown a harmartoma to contain
fibrous elements that may be specular in their reflections with
hypoechoic texture. The mass is encapsulated and distinct from
surround tissue.
Hamartoma: Ultrasonogram demonstrates a 3-cm lobulated circumscribed mass that is predominantly hypoechoic (arrows). Some of the fatty tissue within the lesion is hyperechoic (arrowheads), although this is not seen in all hamartomas.
Hamartoma: Ultrasonogram demonstrates a 3-cm lobulated circumscribed mass that is predominantly hypoechoic (arrows). Some of the fatty tissue within the lesion is hyperechoic (arrowheads), although this is not seen in all hamartomas.
This mass is a solitary, slow growing lesion that presents in
the middle aged and postmenapausal female.
The patient is usually asymptotic.
The ultrasound appearance would be similar to normal fatty
lobules found in a normal breast. The lipoma is hypoechoic
in texture. The sound is attenuated and scattered similar to
normal subcutaneous and intrammary fat.
This mass is a solitary, slow growing lesion that presents in
the middle aged and postmenapausal female.
The patient is usually asymptotic.
The ultrasound appearance would be similar to normal fatty
lobules found in a normal breast. The lipoma is hypoechoic
in texture. The sound is attenuated and scattered similar to
normal subcutaneous and intrammary fat.
Lipoma.Lipoma.
A small percentage of patients have lymphoma as a primary
condition, most have metastatic disease secondary to
lymphoma.
It usually is found in the older patient with a right side
predominance. The mass varies from well defined to infiltrative
with poorly defined borders.
On ultrasound the texture is hypo to isoechoic without through
transmission. Axillary nodes are present in 35% of patients.
A small percentage of patients have lymphoma as a primary
condition, most have metastatic disease secondary to
lymphoma.
It usually is found in the older patient with a right side
predominance. The mass varies from well defined to infiltrative
with poorly defined borders.
On ultrasound the texture is hypo to isoechoic without through
transmission. Axillary nodes are present in 35% of patients.
LymphomaLymphoma
There is a 1% incidence of metastases to the breast from
primary tumors that include malignant melanoma, ovarian
carcinoma, and leukemia/lymphoma.
The mean age affected is 45 years.
The mass is usually solitary and well circumscribed and
appears in the upper outer quadrant.
One fourth of the patients have skin adherence and 40%
have axillary node involvement.
There is a 1% incidence of metastases to the breast from
primary tumors that include malignant melanoma, ovarian
carcinoma, and leukemia/lymphoma.
The mean age affected is 45 years.
The mass is usually solitary and well circumscribed and
appears in the upper outer quadrant.
One fourth of the patients have skin adherence and 40%
have axillary node involvement.
Metastases To The BreastMetastases To The Breast
ultrasound from a 35 year-old patient with bilateral palpable breast
masses. The ultrasound documented a 19 × 14 mm hypoechoic mass.
She was found to have metastatic disease to her breast from a lung
neuroendocrine carcinoma.
Right breast Left breast
A sarcoma is a rare malignant mammary lesion occuring in the
middle aged female. The growth is rapid. Borders are well-defined
with lobulations.
Angiosarcoma is a highly malignant vascular breast tumor that
affects females in the third to fourth decade of life. The mass
gradually enlarges; its borders are ill-defined and there is skin
thickening with nipple retraction. On ultrasound angiosarcoma
presents as a well-defined multilobulated hypoechoic mass with
hyperechoic areas as a result of hemorrhage.
A sarcoma is a rare malignant mammary lesion occuring in the
middle aged female. The growth is rapid. Borders are well-defined
with lobulations.
Angiosarcoma is a highly malignant vascular breast tumor that
affects females in the third to fourth decade of life. The mass
gradually enlarges; its borders are ill-defined and there is skin
thickening with nipple retraction. On ultrasound angiosarcoma
presents as a well-defined multilobulated hypoechoic mass with
hyperechoic areas as a result of hemorrhage.
Sarcoma and AngiosarcomaSarcoma and Angiosarcoma