196 • kemp et al.
Invasive Ductal Carcinoma Arising within a Large Mammary Hamartoma Tamara L. Kemp, MD, Mark R. Kilgore, MD, and Sara H. Javid, MD Department of Surgery, University of Washington Medical Center, Seattle, Washington
A
50-year-old woman presented with an enlarging right breast mass. She was known to have bilateral breast hamartomas, previously stable on annual imaging. Physical exam revealed a large mass involving the entire upper outer quadrant of the right breast, as well as a smaller mass in the upper outer quadrant of the left breast. There was no nipple discharge, nipple retraction, skin change, or palpable lymphadenopathy. Diagnostic mammogram demonstrated a 16.7 cm right breast adenolipofibroma (mammary hamartoma) with characteristic surrounding lucent fat stripe (Fig. 1), and a smaller, circumscribed left breast mass, also consistent with hamartoma. A 3.0 cm simple cyst was noted within the right breast hamartoma. Ultrasound performed at that time confirmed this as a simple cyst, and identified no solid mass lesions or shadowing. The patient represented 1 month later with continued concern over the increasing size of her right breast. Given a strong family history of premenopausal breast cancer in both her mother and sister, in addition to the patient having extremely dense breasts, magnetic resonance imaging (MRI) was pursued. MRI revealed striking, asymmetrically increased right breast and right hamartoma enhancement as compared to the left (Fig. 2), and a concerning area of additionally increased enhancement with architectural distortion along the inferolateral posterior aspect of the right breast hamartoma (Fig. 2, arrow). A corresponding area of shadowing was noted on targeted ultrasound (Fig. 3), and biopsy revealed invasive ductal carcinoma.
Address correspondence and reprint requests to: Tamara L. Kemp, Department of Surgery, University of Washington, 2411 S. Spencer St., Seattle, WA 98108, USA, or e-mail: [email protected] DOI: 10.1111/tbj.12378 © 2015 Wiley Periodicals, Inc., 1075-122X/15 The Breast Journal, Volume 21 Number 2, 2015 196–197
Figure 1. CC mammographic view of right breast demonstrating an encapsulated 16.7 cm hamartoma in the right upper-outer quadrant (arrow), with fibrocystic type change, but no evidence of malignancy.
Right skin-sparing mastectomy and axillary sentinel lymph node biopsy was performed. Three sentinel lymph nodes were positive for metastatic carcinoma, and completion axillary lymph node dissection was performed. The mass was comprised of varying amounts of dense fibrous stroma with interposed adipose tissue and foci of haphazardly arranged ducts and lobules. Nottingham grade 2 invasive ductal carcinoma and high-grade ductal carcinoma in situ were intermixed among the hamartomatous changes, spanning 12.5 cm, and involving 12 of 26 axillary lymph nodes.
Imaging and Pathologic Characteristics • 197
Figure 2. MRI showing the circumscribed mammary hamartomas laterally in both breasts with dense fibroglandular tissue and cysts. Note the marked asymmetric enhancement of the right breast and right hamartoma as compared to left, and the concerning area of increased enhancement with architectural distortion at the posterolateral margin of the hamartoma (arrow).
Mammary hamartomas are very rare, characteristically benign, slow-growing breast tumors. They are not a marker for increased relative risk for breast cancer development, and excision is not typically advised. The occurrence of malignancy in these tumors is extremely rare. Ours is the first reported case of malignant hamartoma in which initial routine breast imaging was benign, and subsequent diagnosis made based on abnormal MRI findings and resultant needle sampling. This case demonstrates the importance of recommending further imaging and/or histologic sampling if on either patient self-exam or clinical breast exam, a breast mass grows or exhibits features atypical of a hamartoma.
Figure 3. Ultrasound of right breast at the time of MRI shows diffuse shadowing in the area corresponding to the region of increased enhancement on MRI.
DISCLAIMER I am a military service member (or employee of the U.S. Government). This work was prepared as part of my official duties. Title 17, USC, §105 provides that ‘Copyright protection under this title is not available for any work of the U.S. Government.’ Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.
Imaging and Pathologic Characteristics of Breast Amyloidosis Mohammad Eghtedari, MD, PhD,* Basak E. Dogan, MD,* Michael Gilcrease, MD, PhD,† Jordan Roberts, MD,† Elise D. Cook, MD,‡ and Wei T. Yang, MD* *Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas; † Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas; ‡Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas Address correspondence and reprint requests to: Wei Yang, MD, Anderson Cancer Center, Section of Breast Imaging, Diagnostic Radiology, 1515 Holcombe Blvd., Unit 1350, Houston, TX 77030, USA, or e-mail: [email protected] DOI: 10.1111/tbj.12381 © 2015 Wiley Periodicals, Inc., 1075-122X/15 The Breast Journal, Volume 21 Number 2, 2015 197–199
A
n 80-year-old female presented with enlarging left breast mass, weight loss, chills, night sweats, and progressive fatigue over 3 months. She was diagnosed with amyloidosis 17 years ago and her left breast
Copyright of Breast Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Invasive Ductal Carcinoma Arising within a Large Mammary Hamartoma Tamara L. Kemp, MD, Mark R. Kilgore, MD, and Sara H. Javid, MD Department of Surgery, University of Washington Medical Center, Seattle, Washington
A
50-year-old woman presented with an enlarging right breast mass. She was known to have bilateral breast hamartomas, previously stable on annual imaging. Physical exam revealed a large mass involving the entire upper outer quadrant of the right breast, as well as a smaller mass in the upper outer quadrant of the left breast. There was no nipple discharge, nipple retraction, skin change, or palpable lymphadenopathy. Diagnostic mammogram demonstrated a 16.7 cm right breast adenolipofibroma (mammary hamartoma) with characteristic surrounding lucent fat stripe (Fig. 1), and a smaller, circumscribed left breast mass, also consistent with hamartoma. A 3.0 cm simple cyst was noted within the right breast hamartoma. Ultrasound performed at that time confirmed this as a simple cyst, and identified no solid mass lesions or shadowing. The patient represented 1 month later with continued concern over the increasing size of her right breast. Given a strong family history of premenopausal breast cancer in both her mother and sister, in addition to the patient having extremely dense breasts, magnetic resonance imaging (MRI) was pursued. MRI revealed striking, asymmetrically increased right breast and right hamartoma enhancement as compared to the left (Fig. 2), and a concerning area of additionally increased enhancement with architectural distortion along the inferolateral posterior aspect of the right breast hamartoma (Fig. 2, arrow). A corresponding area of shadowing was noted on targeted ultrasound (Fig. 3), and biopsy revealed invasive ductal carcinoma.
Address correspondence and reprint requests to: Tamara L. Kemp, Department of Surgery, University of Washington, 2411 S. Spencer St., Seattle, WA 98108, USA, or e-mail: [email protected] DOI: 10.1111/tbj.12378 © 2015 Wiley Periodicals, Inc., 1075-122X/15 The Breast Journal, Volume 21 Number 2, 2015 196–197
Figure 1. CC mammographic view of right breast demonstrating an encapsulated 16.7 cm hamartoma in the right upper-outer quadrant (arrow), with fibrocystic type change, but no evidence of malignancy.
Right skin-sparing mastectomy and axillary sentinel lymph node biopsy was performed. Three sentinel lymph nodes were positive for metastatic carcinoma, and completion axillary lymph node dissection was performed. The mass was comprised of varying amounts of dense fibrous stroma with interposed adipose tissue and foci of haphazardly arranged ducts and lobules. Nottingham grade 2 invasive ductal carcinoma and high-grade ductal carcinoma in situ were intermixed among the hamartomatous changes, spanning 12.5 cm, and involving 12 of 26 axillary lymph nodes.
Imaging and Pathologic Characteristics • 197
Figure 2. MRI showing the circumscribed mammary hamartomas laterally in both breasts with dense fibroglandular tissue and cysts. Note the marked asymmetric enhancement of the right breast and right hamartoma as compared to left, and the concerning area of increased enhancement with architectural distortion at the posterolateral margin of the hamartoma (arrow).
Mammary hamartomas are very rare, characteristically benign, slow-growing breast tumors. They are not a marker for increased relative risk for breast cancer development, and excision is not typically advised. The occurrence of malignancy in these tumors is extremely rare. Ours is the first reported case of malignant hamartoma in which initial routine breast imaging was benign, and subsequent diagnosis made based on abnormal MRI findings and resultant needle sampling. This case demonstrates the importance of recommending further imaging and/or histologic sampling if on either patient self-exam or clinical breast exam, a breast mass grows or exhibits features atypical of a hamartoma.
Figure 3. Ultrasound of right breast at the time of MRI shows diffuse shadowing in the area corresponding to the region of increased enhancement on MRI.
DISCLAIMER I am a military service member (or employee of the U.S. Government). This work was prepared as part of my official duties. Title 17, USC, §105 provides that ‘Copyright protection under this title is not available for any work of the U.S. Government.’ Title 17, USC, §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.
Imaging and Pathologic Characteristics of Breast Amyloidosis Mohammad Eghtedari, MD, PhD,* Basak E. Dogan, MD,* Michael Gilcrease, MD, PhD,† Jordan Roberts, MD,† Elise D. Cook, MD,‡ and Wei T. Yang, MD* *Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas; † Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas; ‡Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas Address correspondence and reprint requests to: Wei Yang, MD, Anderson Cancer Center, Section of Breast Imaging, Diagnostic Radiology, 1515 Holcombe Blvd., Unit 1350, Houston, TX 77030, USA, or e-mail: [email protected] DOI: 10.1111/tbj.12381 © 2015 Wiley Periodicals, Inc., 1075-122X/15 The Breast Journal, Volume 21 Number 2, 2015 197–199
A
n 80-year-old female presented with enlarging left breast mass, weight loss, chills, night sweats, and progressive fatigue over 3 months. She was diagnosed with amyloidosis 17 years ago and her left breast
Copyright of Breast Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
