Lesions of the Skin and Superficial Tissue at Breast MR Imaging

Abstract

Although numerous studies have outlined the benefits of contrast material-enhanced magnetic resonance (MR) imaging for the detection of breast parenchymal findings, the assessment of lesions of the skin and superficial tissue at breast MR imaging has largely been overlooked. Such lesions, both benign and malignant, are commonly encountered at breast MR imaging, and their detection and diagnosis are often imperative. These lesions include superficial, locally extensive, inflammatory, and recurrent breast cancers; iatrogenic changes; sebaceous cysts; and less prevalent diseases such as granulomatous mastitis and angiosarcomas, among others. As MR imaging continues to be used with increasing frequency in both the screening and diagnostic settings, these lesions will be encountered more often; consequently, a better understanding of which lesions may be ignored and which require further evaluation will become increasingly important. Frequently, MR imaging alone may not clearly indicate the cause of lesions of the breast skin and superficial tissue. However, radiologists should thoroughly assess such lesions, taking into consideration the spectrum of possible causes. Mammography, ultrasonography, consultation with clinicians or dermatologists regarding physical examination findings, and, when necessary, correlation with pathologic findings in biopsy specimens may be used in conjunction with MR imaging to establish both the importance of these lesions and their definitive diagnoses.

An entity mimicking inflammatory breast carcinoma: Granulomatous mastitis

“…GM is a rare inflammatory disease of the breast to represent between 0.025% and 3% [2][3][4][5][6][7][8]. It is characterized by granulomas and abscess formation [2][3][4].…”

“…Though it can be seen bilaterally, it is mostly unilaterally occurring in young woman < 50 years of age, who usually present during lactation or within 6 years of pregnancy [2]. The importance of this entity is not only because it mimics inflammatory breast carcinoma (IBC), but it may also be indistinguishable from IBC at mammography and MR [2,3,5]. These patients may present with findings like breast lump with or without skin changes like "peau d'orange" skin, ulceration and nipple inversion.…”

“…Ultrasound will show heterogeneous breast mass with ill defined margins. The Doppler ultrasound examination is shown to reveal increased vascularity of the lesions and the surrounding tissue [2][3][4][5]. Ultrasound may also show abscess formation [2,3].…”

Pilomatricoma of the breast in an adolescent girl: sonographic findings

“…Benign lesions include dermal nevus, seborrheic keratosis, epidermal inclusion cyst, sebaceous cyst, neurofibroma, cutaneous granular cell tumor, hemangioma, and lesions arising from the anterior terminal ductolobular unit, such as papilloma, adenosis, and fibroadenoma. Malignant lesions include superficial breast cancer, cutaneous metastasis, primary skin cancers, cutaneous angiosarcoma, and dermatofibrosarcoma protuberance [16,17].…”

Mesenchymal breast lesions

“…2 They typically measure <2 cm. 3 Most commonly they are located in the subdermal or subcutaneous soft tissues.…”