Mesenchymal Lesions of the Breast: What Radiologists Need to Know

Abstract

Although many mesenchymal tumors exhibit characteristic findings on imaging, others show nonspecific characteristics and require tissue biopsy for diagnosis. An awareness of the clinical and imaging presentation is essential in guiding the differential diagnosis and patient management.

Spontaneous Angiolipoma in Autologous Flap Reconstruction

“…Angiolipomas are typically less than 2 cm in size and may be solitary or multiple in number [5][6][7]. Their imaging appearance on mammography, ultrasound, and MRI is nonspecific [5][6][7]9], although the most characteristic finding is a homogeneously or heterogeneously hyperechoic mass, with associated vascularity and no posterior acoustic shadowing [6,7]. Main differential considerations include other benign entities that may present as hyperechoic masses, commonly fat necrosis and hematoma, or, in rare cases, spindle cell lipoma, another rare benign fatcontaining tumor [3,5,10].…”

“…Although a breast hematoma may also be hyperechoic, it tends to be more heterogeneous in echogenicity and often has an associated history of trauma or surgery [ 5 ]. Lipomas of the breast have echogenicity similar to the fat tissue that is hypoechoic compared to the relatively hyperechoic fibroglandular tissue of the breast [ 5 , 9 ]. In addition, lipomas are typically avascular [ 9 ].…”

“…Lipomas of the breast have echogenicity similar to the fat tissue that is hypoechoic compared to the relatively hyperechoic fibroglandular tissue of the breast [ 5 , 9 ]. In addition, lipomas are typically avascular [ 9 ]. When a mass demonstrates irregular margins, suspicious calcifications, thick hyperechoic capsule, or increasing size, malignancy should be considered [ 5 , 8 ].…”

“…However, if a homogeneously hyperechoic mass is seen on ultrasound without posterior acoustic shadowing and there are no other suspicious findings on additional imaging, both angiolipoma and spindle cell lipomas should be entertained as likely differential considerations. Neither has known malignant potential, but because of the paucity of knowledge about these entities, these are frequently biopsied and surgically excised [ 6 , 9 , 10 ]. This may be especially true when there is a history of breast cancer, as was the case with our patient (Table 1 ).…”

Radiation-Induced Undifferentiated Pleomorphic Sarcoma after Breast Conserving Therapy: Case Report

“…Breast sarcomas can occur as a primary tumor and as a secondary form associated with a history of radiation therapy. Some authors 6 describe UPS as the most common histopathological type 6 , others as angiosarcomas 3,7 ; nevertheless, sarcomas following irradiation of breast cancer are rare and cumulative incidence is about 0.2% in 10 years 8 . They occur predominantly in 45-50 years old patients 9 .…”