Breast imaging
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Typical lymph nodes (Figs 12.9a, b) have a fatty centre and hilum, oil cysts are well-defined and of fatty density and duct ectasia may produce typical coarse ductal rod- or tube-like calcifications. Many abnormalities, however, do not show diagnostic features and require further assessment by ultrasound and/or biopsy. Simple cysts are very common and appear as round, well-defined masses or clusters of masses, but there are no mammographic signs that are absolutely diagnostic of a cyst, so ultrasound or aspiration is usually required for diagnosis. Some lesions are notoriously difficult to diagnose and closely mimic malignancy. One such is radial scar (Fig. 12.9c), which produces a spiculated area, often with an apparent small central mass. These are surgically removed, as even CBx does not exclude malignancy next to a scar. Fat necrosis may produce all the features of malignancy and even at histology can be difficult to diagnose.
Mammography and Interventional Breast Procedures
Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack in Radionuclide Imaging of the Breast, 2021
Some shapes are typically benign and do not require biopsy. Isolated shell-like or spherical calcifications with radiolucent center are always benign. These may occur in areas of fat necrosis [48]. The extrusion of cellular debris into the tissues around the ducts can result in an inflammatory reaction and produce extensive thick, rod-shape calcification seen in "plasma cell mastitis" [47]. Solid rod shaped calcifications, which may form within the duct, are benign mammographic findings. Since the benign process does not narrow the lumen and may in fact lead to duct ectasia, these calcifications are generally larger than the fine, irregular intraductal deposits found in malignancy [54]. Tubular (lucent-centered rods) calcifications that are oriented along duct lines, rarely branched, and thicker than 0.5 mm are virtually always a form of benign secretory deposit within the normal or dilated ducts or the periductal stroma [52,54].
The breasts
C. Simon Herrington in Muir's Textbook of Pathology, 2020
The importance of fat necrosis lies mainly in its propensity to mimic cancer, as it may present as a firm mass, nipple retraction or mammographically with radiological calcification. It is caused by injury to the fat cells of the breast, although the trauma may be relatively minor and not reported by the patient. This causes leakage of lipid and a subsequent inflammatory reaction. Initially there may be associated haemorrhage and acute inflammation, but macrophages soon collect and take on a foamy appearance due to lipid in the cytoplasm, and a foreign-body giant cell reaction (Figure 16.13). Subsequently fibrosis is seen, hence the clinically mimicry of carcinoma, often with microcalcification in the stroma.
I-131 uptake in the breast from fat necrosis
Published in Baylor University Medical Center Proceedings, 2019
Joseph T. Hoang, Matthew R. Weissenborn, Joseph J. Spigel, Brian J. Welch, Stanley J. Grossman
Fat necrosis of the breast is a benign inflammatory process that is commonly caused by trauma, breast surgery, radiation therapy, or diagnostic breast interventions.10 Fat necrosis appears as an area of hemorrhage in fat that is surrounded by lipid-laden macrophages, histiocytes, and multinucleated giant cells. Fibrosis and calcification from fibroblasts appear in later stages.11,12 The mechanism of radioiodine uptake in fat necrosis of the breast is poorly understood. Only one previous case of I-131 uptake in the breast from fat necrosis has been reported in the literature.13 The differential for iodine uptake in the chest includes pathologic and inflammatory processes in the lungs, mediastinum, chest wall, and breast. Additional imaging can help determine the true location and etiology for I-131 uptake in the chest.
Regenerative application of stromal vascular fraction cells enhanced fat graft maintenance: clinical assessment in face rejuvenation
Published in Expert Opinion on Biological Therapy, 2020
Pietro Gentile, Aris Sterodimas, Claudio Calabrese, Barbara De Angelis, Angelo Trivisonno, Jacopo Pizzicannella, Laura Dionisi, Domenico De Fazio, Simone Garcovich
Injected fat tissue survival was evaluated with instrumental MRI and ultrasound. The patients treated with FG-SVFs showed 61% maintenance of the contour restoring and of three-dimensional volume after 3 years compared with the patients of the CG treated with FG, who showed 31% maintenance. In 60.7% (n = 20) of patients treated with FG-SVFs, we observed a restoration of the face contour and an increase of 6.6 millimeters in the 3-dimensional volume after 36 months, which was reported in only 33,3% (n = 10) of patients in the CG. Volumetric persistence in the SG was higher than that in the CG (p < . 0001 vs. CG). MRI has detected cyst formation, micro calcifications, macro calcifications, and cytosteatonecrotic areas. Cyst formation and calcifications were identified in 3 patients in the SG and in 4 patients in the CG (p = 0.053). Fat necrosis was not identified. 2 patients in the CG underwent a second treatment. In the long-term follow-up, side effects like infections and skin necrosis were not observed in either group.
Orbital Mass as the Only Presenting Sign with Overlapping Features of Lupus Erythematosus Panniculitis and Subcutaneous Panniculitis-Like T-Cell Lymphoma
Published in Ocular Immunology and Inflammation, 2023
Mehmet Serhat Mangan, Ahmet Murat Sarici, Ozben Yalcin, Demet Aydin, Gulcin Yegen, Emire Seyahi
Panniculitis-like T-cell infiltration and the presence of accompanying atypical lymphoid cells are in favor of lymphoma.10 SPTCL typically has a dominance of CD8+ lymphocytes.10 In our case, 75% of T lymphocytes were CD4+, and 25% of T lymphocytes were CD8+, but also included B-lymphocyte aggregates (CD20+, Bcl2+). Distinct adipocyte rimming is in favor of lymphoma, but not specific to it.11,12 Even though the presence of atypical lymphocytes contravenes with LEP,7 the infiltrating cells in our case were mainly small lymphocytes with occasional atypical lymphocytes. The presence of plasma cells and CD20 + B-cells, as in our patient, is also in favor of LEP.3,12 Also, fat necrosis, commonly observed in SPTCL, was not present. The T-cell receptor clonality test is helpful in the distinction of SPTCL and benign panniculitis.1 We did not observe clonal T lymphocyte proliferation in our case. Bosisio et al. reported that granulomas containing areas of necrosis and histiocytic infiltration can be encountered in cases of SPTCL and LEP.3,8 We also observed abscess-forming necrotizing granulomatous lymphadenitis in the lymph node biopsy of our case. This mandated differential diagnosis with tuberculosis but the PPD test of our patient was negative.
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