Sarcomas of the breast: findings on mammography, ultrasound, and magnetic resonance imaging

Abstract

Sarcomas of the breast belong to a heterogeneous group of breast tumors of mesenchymal origin, without epithelial components. These tumors can be primary or secondary (after previous treatment for breast cancer), are rare, present aggressive behavior, and have a poor prognosis. They occur mainly in women between 45 and 50 years of age, with the exception of angiosarcomas, which can occur in younger patients. Clinically, breast sarcomas manifest as palpable, mobile, rapidly growing masses, without skin thickening, axillary lymphadenopathy, or nipple discharge. Although the imaging findings are non specific, they can be suggestive of sarcoma. For instance, a solitary mass showing rapid growth, with circumscribed or indistinct margins and, a complex (solid-cystic) or heterogeneous echotexture, without axillary lymph node involvement, can raise the suspicion of sarcoma. The treatment is not well established, because of the rarity and heterogeneity of this type of neoplasm. The principles of treatment for sarcoma of the breast have been addressed only in small cohort studies. In most cases, the treatment of choice is surgery without axillary lymphadenectomy.

Keywords: Breast cancer; Magnetic resonance imaging; Mammography; Sarcoma; Ultrasonography.

Figure 1

A 52-year old woman who previously underwent bilateral mastectomy for invasive ductal carcinoma. Right breast reconstruction with a transverse rectus abdominis muscle flap. The patient had undergone radiotherapy 12 years before. Mammogram showing an irregular, spiculated, hyperdense, 8-cm mass in the right breast.

Figure 2

A 42-year-old woman with a palpable mass in the left breast (radiopaque marker). Mammogram showing a round, circumscribed, hyperdense mass, measuring 5.0 cm in diameter, in the upper outer quadrant of the left breast (arrows). Pathological diagnosis: fibrosarcoma.

Figure 3

A 78-year-old woman, who underwent right mastectomy for invasive ductal carcinoma 30 years prior, with a palpable mass in the left breast. Mammogram showing an irregular hyperdense mass, with indistinct margins, in the upper outer quadrant of the left breast (arrows). Pathological diagnosis: leiomyosarcoma.

Figure 4

Mammogram of a 46-year-old woman with a palpable, high-density, oval, circumscribed, noncalcified mass in the lower inner quadrant of the right breast.

Figure 5.

A: A 55-year-old woman with a palpable mass, showing rapid growth, in the left breast. B,C: Ultrasound showing a complex nodule with a solid component (asterisk) and a cystic component (#), together with an oval morphology and circumscribed margins, occupying the entire left breast. Pathological analysis: undifferentiated pleomorphic sarcoma.

Figure 6

Ultrasound of a 48-year-old woman showing an oval, circumscribed, heterogeneous mass with a diameter of 4.5 cm, occupying the entire left breast. Pathological analysis: fibrosarcoma.

Figure 7

A: MRI showing a huge irregular mass with peripheral enhancement and necrotic areas. B: Kinetic study of the mass showing a plateau curve of contrast enhancement.

Figure 8

A 42-year-old woman with a palpable mass in the right breast. A: T2-weighted imaging showing an oval, circumscribed, complex mass, with cystic and solid areas (arrow). B: Contrast-enhanced T1-weighted imaging showing enhancement of the solid portion (arrow).

Figure 9

A 53-year-old man with a palpable, rapidly growing mass in the right breast. A: Mammography showing an oval, circumscribed, hyperdense mass, with faint calcifications, occupying the entire right breast (arrow). B: Ultrasound showing a solid, oval, circumscribed, heterogeneous mass (arrow) with internal vascularity on the Doppler flow study. C: Contrast-enhanced MRI (T1-weighted subtraction) showing the same mass, with circumscribed margins and heterogeneous enhancement (arrow). Histopathological diagnosis: liposarcoma.

Figure 10

A: A 19-year-old woman with a rapidly growing mass in the right breast and no risk factors for breast carcinoma. B: Ultrasound showing an irregular, heterogeneous mass with indistinct margins, occupying all outer quadrants of the right breast. Histopathological diagnosis: phyllodes tumor.