Four cases of echogenic breast lesions: a case series and review

Abstract

Echogenic breast lesions are generally thought to be benign. We herein report four cases of echogenic breast lesions that were seen at our centre over 38 months. One patient had a prior history of wide excision and radiotherapy for breast cancer and was imaged as part of routine cancer surveillance, while the other three were recalled for further assessment following an abnormal screening mammogram. All four patients were assessed on ultrasonography, which demonstrated an echogenic lesion in each patient. All four lesions underwent ultrasonography-guided core biopsy, followed by excision biopsy. The indications for biopsy were interval increase in the size of lesion or indeterminate features demonstrated in the lesion. Three lesions were benign, while the lesion from the patient who had received previous radiotherapy was angiosarcoma. Not all echogenic lesions are benign and lesions with suspicious features on ultrasonography should undergo biopsy.

Keywords: angiolipoma; angiosarcoma; echogenic breast lesions; myofibroblastoma.

Fig. 1

Case 1: (a & b) Coned compression cranial-caudal and mediolateral-oblique mammogram images of the upper outer quadrant of the right breast obtained after ultrasonography (a marker was placed over the lump seen on the US image) show no demonstrable density or calcification. (c) US images show an irregular echogenic mass at the ‘9 o’clock’ position, 4.5 cm from the nipple. No internal vascularity was seen. Photomicrographs show (d) ectatic vessels containing red blood cells dispersed within the fibroadipose breast parenchyma (Haematoxylin & eosin, low magnification); and (e) luminal protuberances into the vascular space, which is lined by relatively bland and flattened endothelial cells; the vessels extend into the interstices of the adipose stroma (Haematoxylin & eosin, high magnification).

Fig. 2

Case 2: (a) Mediolateral-oblique (MLO) and cranial-caudal (CC) screening mammogram images obtained in 2008 show a tiny nodule (arrowheads) in the lower medial quadrant. (b) MLO and CC screening mammogram images obtained in 2010 show a well-defined nodule (arrows) in the lower medial quadrant; the nodule, when compared to the one seen in 2008, has increased in size. (c) US image reveals a heterogeneous nodule with an echogenic rim (between arrows). Photomicrographs show (d) a tight collection of congested capillaries, with a partially circumscribed boundary (Haematoxylin & eosin, low magnification); and (e) several fibrin thrombi within the capillaries of the angiolipoma (Haematoxylin & eosin, high magnification).

Fig. 3

Case 3: (a & b) Mediolateral-oblique and cranial-caudal screening mammogram images show nodular densities (arrows) in the lower medial aspect of the right breast. (c) US image shows a predominantly hyperechoic mass in the lower inner quadrant. Photomicrographs show (d) a circumscribed lesion composed of an admixture of mature adipocyte lobules, with tight congeries of congested capillaries (Haematoxylin & eosin, low magnification); and (e) a few fibrin thrombi within the capillaries (Haematoxylin & eosin, high magnification).

Fig. 4

Case 4: (a & b) Mediolateral-oblique and cranial-caudal screening mammogram images show a well-defined mass in the upper outer quadrant of the left breast; the mass was larger than the mass observed in the mammogram images obtained two years earlier. (c) US image shows a well-defined mass with an echogenic centre and a hypoechoic rim. Photomicrographs show (d) the border of the myofibroblastoma, with a few small lobules near the periphery; the lobules of mature adipocytes are interspersed with fibrous zones that are variably oedematous (Haematoxylin & eosin, low magnification); and (e) bland spindle cell nuclei among pink collagen bands (Haematoxylin & eosin, high magnification).