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Image of the Month—Quiz Case
Fernando Hernanz, MD;
Pilar Alonso-Bartolomé, MD;
Francisca Garijo, MD;
Alfonso Vega, MD;
Estrella Ortega, MD;
Angel Alvarez, MD;
Manuel Gómez-Fleitas, MD
Arch Surg. 2007;142(2):201.
INTRODUCTION
A 26-year-old white woman without risk factors for breast cancer had progressive enlargement of her left breast. There were no others symptoms. Physical examination revealed a large, painless, rubbery-firm, well-circumscribed, lobulated, mobile mass at the outer inferior quadrant of the left breast. There were no palpable axillary lymph nodes. Sonography showed a hypoechogenic mass with a 7.5-cm diameter, well-defined borders, and sporadic cyst areas in the periphery. Mammography showed an increased density at the inferior quadrants without calcifications (Figure 1). Core-needle biopsy revealed a benign feature: pseudoangiomatous stromal hyperplasia. Clinical follow-up was recommended. After 10 months, the patient experienced a significant increase in the size of the mass without other associated symptoms. Magnetic resonance imaging was performed. The images confirmed the presence of a well-encapsulated lesion measuring 11 cm in diameter. On T1-weighted imaging, the mass was isointense to the muscle with a homogeneous signal along the mass. On T2-weighted imaging, the mass was isointense to the mammary parenchyma. Contrast-enhanced, fat-suppressed fast-spoiled gradient-recalled echo images revealed a type II time-signal intensity curve and an intense ring-enhancing mass with large arteries and veins going to the mass (Figure 2). Surgical excision was indicated.
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Figure 1. Mammogram shows a dense mass without calcifications.
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Figure 2. Gadolinium contrast-enhanced image revealed an intense ring-enhancing mass with large arteries and veins going to the mass.
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What Is the Diagnosis?
A. Phyllodes tumor
B. Angiosarcoma
C. Hamartoma
D. Fibroadenoma
Answer
Author Affiliations: Divisions of General Surgery (Drs Hernanz and Gómez-Fleitas), Radiology (Drs Alonso-Bartolomé, Vega, and Ortega), Pathology (Dr Garijo), and Gynecology (Dr Alvarez), Hospital Universitario Marqués de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain.
RELATED ARTICLE
Image of the Month—Diagnosis
Arch Surg. 2007;142(2):202.
EXTRACT
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