isoechoic mass on ultrasoundespn conference usa football teams 2023

The echogenicity of fat in the breast is at the middle of the gray-scale spectrum. Often termed a breast within a breast, breast hamartomas are circumscribed benign tumors that are composed of variable amounts of fat, fibrous tissue, and glandular tissue. Positron emission tomography (PET)/CT can show fluorodeoxyglucose avidity (Fig. Recurrence after excision of PASH has been reported at rates from 5 to 22% [43, 48]. Presence of T2-hyperintense slit-like spaces with cystic components favors the PASH diagnosis favors the diagnosis of PASH (Fig. Terms and Conditions, Pseudoangiomatous stromal hyperplasia (PASH) is a benign breast entity that presents with a wide spectrum of imaging features. In recent years, expectant conservative management is becoming the treatment of choice, especially in mild cases. Grayscale (c) and color Doppler breast ultrasound (d) reveals multiple retroareolar, vascular masses (arrows). B: Contrast-enhanced ultrasound showing a small hypovascular mass in the posterior aspect of the left kidney. T1-weighted non-fat-suppressed (c) and T1-weighted fat-suppressed (d) post-contrast MRI images show a well-circumscribed, heterogeneously enhancing breast mass suspicious for a sarcoma (arrow). Lipomas appear as soft variably echogenic masses, commonly encountered on ultrasound. Ann Surg Oncol 16(9):25872593, Bonvalot S, Terns N, Fiore M et al (2013) Spontaneous regression of primary abdominal wall desmoid tumors: more common than previously thought. Repeat biopsy under MRI guidance confirmed the diagnosis of fat necrosis. The reason why any lesion is visible on mammography or USG is the relative difference in the density and acoustic impedance of the lesion, respectively, as compared to the surrounding breast tissue. 2007;12(6):533-41. Nishida J, Morita T, Ogose A et al. 3c) [11]. In lactating patients, although mammography is initially delayed until the acute symptoms of mastitis resolve following a course of antibiotics, mammography is indicated when there is a clinical suspicion for malignancy and in those with a prolonged clinical course [5, 6]. 11a, c) [43]. 8. Hamartomas are uncommon, slow-growing tumors that represent 4.8% of benign breast tumors [38,39,40]. On sonography, it has a more variable appearance, from the more common and benign-appearing oval, circumscribed hypoechoic mass (Fig. As a malignant mass enlarges, especially if high grade, it becomes more heterogeneous with hypoechoic areas of internal necrosis and increased flow on color and power Doppler imaging. Radiology. Grayscale and color Doppler ultrasound images (d, e) reveal a vascular, mixed cystic, and solid mass correlating with the area of palpable abnormality. Mammographically, tubular adenomas have been associated with tightly grouped microcalcifications, which can be suspicious in morphology and may warrant biopsy [61]. A 52-year-old woman with remote history of mastopexy presented with a palpable breast mass. Pathologically, it is characterized by a non-caseating granulomatous inflammatory process of the breast lobules without an identifiable infectious or inflammatory etiology [9, 10]. PubMedGoogle Scholar. However, there are other imaging findings that can closely mimic malignancy: suspicious mammographic features of fat necrosis include irregular and spiculated masses, architectural distortion, asymmetries, coarse heterogeneous and even branching or pleomorphic calcifications. The patient underwent surgical excision. Pseudoangiomatous stromal hyperplasia. To date, there is no evidence that lymphocytic mastopathy is associated with an increased risk of developing lymphoma [22, 25]. A small amount of non-adipose components are often present, representing fibrous septa, areas of fat necrosis, blood vessels, and interposed muscle fibers. Granulomatous mastitis is a rare diagnosis of exclusion. 3). On MRI, breast abscesses will typically be T2-hyperintense, have progressive enhancement kinetics, and sometimes have the characteristic thin rim of peripheral enhancement (Fig. Grayscale (d) and power Doppler (f) ultrasound images reveal an irregular mass with posterior acoustic shadowing corresponding to the palpable area. J Ultrasound Med 10(1):4345, Linda A, Londero V, Bazzocchi M, Zuiani C (2008) Desmoid tumor of the breast: radiologic appearance with a focus on its magnetic resonance features. This appearance is consistent with a thyroglossal duct sinus. These may represent areas of fat necrosis, fibrous tissue, blood vessels, or muscle fibers; these lesions cannot be confidently differentiated from liposarcoma by imaging. In cases where PASH is identified as an incidental finding on pathology, no additional intervention is necessary, and clinical and imaging follow-up is recommended [53]. Therefore, close clinical and imaging follow-up is indicated to ensure that there is no interval development of new breast masses [22]. Granulomatous mastitis is an inflammatory breast condition of unknown etiology. Histologically, the differential diagnosis includes a low-grade angiosarcoma and phyllodes tumor [46]. Br J Radiol 87(1039):20140182, Yilmaz R, Bayramoglu Z, Kartal MG et al (2018) Stromal fibrosis: imaging features with diagnostic contribution of diffusion-weighted MRI. ; vol. Abstract. The nodule has smooth, well-defined margins with a very heterogeneous echotexture. Your US state privacy rights, They are the most common soft tissue tumor, seen in ~2% of the population. If a PET/CT is performed, these lesions can be hypermetabolic [31]. Dermatofibrosarcoma protuberans (DFSP) is one of the more common malignant soft tissue tumors and accounts for 6% of soft tissue sarcomas. Ideally, a variety of probe pressures should be used. An inflammatory or infectious etiology such as plasma cell mastitis, granulomatosis with polyangiitis, sarcoidosis, or tuberculous mastitis must be excluded [11]. On MRI, PASH usually presents as a circumscribed mass resembling a fibroadenoma, but it can also present as non-mass enhancement in a focal or segmental distribution (Fig. If all characteristics are those of a simple lipoma, and no local symptoms such as pain are present, then no treatment is generally required. Correspondence to A 47-year-old woman presented with a palpable mass. This pathologic entity can frequently coexist with both benign and malignant breast lesions. A different patient, a 40-year-old woman, was found to have a new breast mass (arrow) on mammography, craniocaudal spot view (c). 2df) [2]. Part of There is associated axillary adenopathy (solid arrow in e). AJR Am J Roentgenol 193(3):856860, Cederlund C-G, Gustavsson S, Linell F, Moquist-Olsson I, Andersson I (1984) Fibromatosis of the breast mimicking carcinoma at mammography. Mammographically, desmoid fibromatosis presents as an irregular, high-density mass with spiculated margins (Fig. Ann Oncol 28(10):23992408, Duazo-Cassin L, Le Guellec S, Lusque A et al (2019) Breast desmoid tumor management in France: toward a new strategy. Treatment and prognosis. Confirmation of a malignant tumor typically initiates staging with thoracic computed tomography (CT) and possibly an isotope bone scan to identify potential metastases. To date, only a single case of PASH with malignant transformation has been reported [52]. In the presence of an enlarging mass, surgical excision is recommended [45, 53]. In patients with a prolonged course and patients whose condition does not respond to antibiotics, breast biopsy is indicated and should not be delayed. The characteristic ultrasound appearance is a solitary complex cystic mass with a well-defined thick fibrous capsule, internal septations, mural nodularity and, occasionally, capsular calcification (Figure 4). 1994 Dec;152(6 Pt 2):2304-7. doi: 10.1016/s0022-5347(17)31663-4. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Sabat JM, Clotet M, Gmez A, De Las HP, Torrubia S, Salinas T (2005) Radiologic evaluation of uncommon inflammatory and reactive breast disorders. On sonography, a hypoechoic irregular mass with posterior acoustic shadowing is usually seen [67]. McGraw Hill Professional, Eastley N, McCulloch T, Esler C et al (2016) Extra-abdominal desmoid fibromatosis: a review of management, current guidance and unanswered questions. Pathol Res Pract 190(4):362371, Adrada BE, Krishnamurthy S, Carkaci S, Posleman-Monetto FE, Ewere A, Whitman GJ (2015) Unusual benign tumors of the breast. PubMed Central Management should be determined by the clinical examination, imaging studies, and core biopsy results [62]. more echogenicity than fat or equal to fibroglandular tissue; PASH is associated with hormone exposure, including oral contraceptive use, and is primarily seen in premenopausal and perimenopausal women on hormone replacement therapy [42, 43]. Although predominantly hypoechoic, there are often heterogeneous anechoic areas due to necrosis, heterogeneity, and increased flow on color and power Doppler imaging. On MRI, hamartomas present as a heterogeneous circumscribed mass with a thick capsule, usually with heterogenous progressive enhancement kinetics [39]. Breast abscess is a complication of infectious mastitis. Ultrasound features of fat necrosis that mimic malignancy include irregular hypoechoic masses with posterior acoustic shadowing (Fig. Ultrasound. Sonograpically, sclerosing adenosis can present as a circumscribed mass, with variable echogenicity. Both fibroadenomas and tubular adenomas present as circumscribed masses and are occasionally palpable. The clinical presentation of several benign breast conditions, common and rare, can mimic breast cancer. Clinical features of fat necrosis include palpable masses, pain, and skin changes such as skin tethering, skin thickening, and dimpling [32]. Granular cell tumor. Breast Care 16:7784, Gavriilidis P, Michalopoulou I, Baliaka A, Nikolaidou A (2013) Granular cell breast tumour mimicking infiltrating carcinoma. Awareness of multiple malignancy mimickers, rare and common, is vital to clinical practice and plays a key role in radiologic-pathologic concordance, ensuring appropriate clinical management. Benign tumors that mimic malignancy include hamartoma, pseudoangiomatous hyperplasia, tubular adenoma, desmoid fibromatosis, and granular cell tumor. Color Doppler imaging has been used to characterize masses and tumor vascularity. If a mass is seen as the presenting imaging feature, it can have irregular margins, although it more commonly has circumscribed margins. Superficial lipomas are typically oval or oblong, well defined, compressible, and show no flow on color or power Doppler imaging. With the advent of tomosynthesis, stromal fibrosis can present as architectural distortion. In this situation, the appearance is nonspecific and similar to any high-grade sarcoma. Findings and clinical presentation were suspicious for inflammatory breast cancer. On ultrasound, angiolipoma is a clearly demarcated, homogeneous, isoechoic to hyperechoic mass with regular margins (Fig. Malignant nodes often have a peripheral or mixed rather than hilar vascular pattern on color and power Doppler imaging. If the entering or exiting nerve is eccentric to the mass, schwannoma may be suggested, whereas in neurofibroma the nerve tends to be central. Stromal fibrosis in the breast is a benign pathologic entity characterized by proliferation of stroma with obliteration of the mammary acini and ducts on pathologic analysis. The ultrasound appearances of liposarcomas tend to fall into three categories. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Breast J 10(4):359362, Tayyab SJ, Adrada BE, Rauch GM, Yang WT (2018) A pictorial review: multimodality imaging of benign and suspicious features of fat necrosis in the breast. Multicentric and bilateral involvement is frequent. Recently published studies have shown no significant difference in event-free survival between asymptomatic patients who underwent surgery and cases managed non-surgically, thereby suggesting that conservative management should precede surgical management [71, 72]. Mediolateral, craniocaudal, and spot tangential mammographic views do not reveal an abnormality (ac, respectively). Eur J Surg Oncol 42(7):10711083, Neuman HB, Brogi E, Ebrahim A, Brennan MF, Van Zee KJ (2008) Desmoid tumors (fibromatoses) of the breast: a 25-year experience. The prognosis of granulomatous mastitis is favorable, although some cases can be refractory to therapy and can develop significant sinus tracts and scarring [11]. The authors declare that they have no competing interests. Ultrasonography can confirm the extratesticular nature of these masses. A mass was not palpable on examination. J Clin Med 9(4):958, CAS Palpation during ultrasound imaging, sonopalpation, is the ultrasound correlate of physical examination. equal echogenicity compared to subcutaneous fat; hyperechoic, i.e. Most malignant masses are predominantly hypoechoic, usually with low-level echoes or heterogeneity, and well defined as they have pseudocapsules. The mass remained stable sonographically for 30months and mammographically for 9years. PET can differentiate between benign and malignant granular cell tumors, with the benign tumors showing a lower standardized uptake value than the cutoff value of 2.5 [79]. volume12, Articlenumber:53 (2021) Similarly, if suspicious features are present, then the sensitivity of MRI is 100% 1, although specificity is lower, as some masses with atypical features will nonetheless be lipomas. The patients symptoms improved over the following 6months. Rare Tumors 4(2):7377, Hargaden GC, Yeh ED, Georgian-Smith D et al (2008) Analysis of the mammographic and sonographic features of pseudoangiomatous stromal hyperplasia. Main cardiac masses consist of thrombi . Grayscale right (b) and left (c) breast ultrasound showsirregular, hypoechoic masses with posterior acoustic shadowing (arrows). This is exemplified in women with dense breast tissue, where USG is useful in detecting small breast cancers that are not detected on mammography. In some cases, the findings are mammographically occult. Suspicious mammographic imaging features of sclerosing adenosis include amorphous, pleomorphic, and punctate calcifications. Variable appearance: May be homogenous hyper-, hypo-, or isoechoic lesion ; Central hyperechoic area (central scar) Hypo- or isodense on noncontrast imaging with a central scar ; Hyperdense during the arterial phase ; Typically isodense during the portal venous phase, although the central scar may become hyperdense as contrast diffuses into the . The application of. Less than 10% of desmoid tumors are found in the breast; more common locations include the abdominal wall, retroperitoneum, and the mesentery. Check for errors and try again. Kransdorf M, Bancroft L, Peterson J, Murphey M, Foster W, Temple H. Imaging of Fatty Tumors: Distinction of Lipoma and Well-Differentiated Liposarcoma. If needed, a short-term follow-up MRI after biopsy may be recommended. Although it can coexist with malignant lesions [49, 50], PASH itself is a benign entity without an increased risk for malignancy [51]. When no suspicious features are present, the diagnosis of lipoma can be made with confidence with MRI being 100% specific 1. T1-weighted non-fat-suppressed ( c ) and T1-weighted fat-suppressed ( d ) post-contrast MRI images show a well-circumscribed, heterogeneously enhancing breast mass suspicious for a sarcoma (arrow). Asian J Surg 43(7):735741, Sengupta S, Pal S, Biswas BK, Phukan JP, Sinha A, Sinha R (2014) Preoperative diagnosis of tubular adenoma of breast10 years of experience. Non-mass enhancement has also been reported [31]. Core needle biopsy showed pseudoangiomatous stromal hyperplasia (PASH). Biopsy is usually indicated to establish the correct diagnosis and to rule out breast cancer. Breast Cancer Res Treat 176(2):329335, Lorenzen J, Cramer M, Buck N et al (2019) Desmoid type fibromatosis of the breast: ten-year institutional results of imaging, histopathology, and surgery. In contradistinction, intermuscular lipomas do not exhibit local invasion and tend to be lobular or dumbbell-shaped, easily separated from adjacent soft tissues during surgical resection 6,7. J Clin Pathol 40(5):535540, Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G (2009) Granulomatous lobular mastitis: imaging, diagnosis, and treatment. Am Surg 76(3):292295, Berna-Serna JD, Madrigal M (2004) Percutaneous management of breast abscesses. PubMed Granulomatous mastitis. Superficial lipomas are typically elliptical, well defined, pliable, and avascular. (2005) ISBN: 0721601871 -. They are usually periareolar and typically have worse outcomes and a higher rate of recurrence than puerperal abscesses. While ultrasound is primarily used to discriminate between cystic and solid masses, there are often features that can limit the differential diagnosis. Excessive pressure may obscure the margins of a soft tissue mass or compress a fluid component. 2a) [2]. 13) [61]. If the sclerosing adenosis is associated with a radial scar, surgical excision is recommended. Grayscale transverse (c) and longitudinal (d) ultrasound show a mixed-echogenicity oval mass correlating with the mammographic finding (arrows). Dr. David Sneid answered Endocrinology 43 years experience Probably benign: Depends on the appearance on ultrasound and also on lab and clinical parameters. Unable to process the form. Mammographically, PASH usually presents as an oval or round, noncalcified mass with circumscribed margins ranging from 0.3 to 11cm (Fig. It is more frequently seen in younger women of childbearing age. Often hypoechoic and peripheral zone lesions are the only areas sampled. Become a Gold Supporter and see no third-party ads. Sclerosing adenosis is a proliferative breast condition of the terminal lobular unit characterized by distortion of the lobules with an increased number of acini and desmoplasia. . Some observations regarding its clinicopathologic spectrum. Solid and complex cystic masses detected on ultrasound require further imaging evaluation with CT and/or MRI for proper characterization. Additional history gained during the ultrasound examination often adds insight to narrow the differential diagnosis. Figure 1: histology - spindle cell lipoma, Case 20: subcutaneous lipoma in nape of neck, Case 28: lipoma causing posterior interosseous neuropathy, Case 35: erector spinae intramuscular lipoma, Post traumatic fat necrosis of the anterior abdominal wall, View Frank Gaillard's current disclosures, View Ashesh Ishwarlal Ranchod's current disclosures, see full revision history and disclosures, WHO classification of soft tissue and bone tumors (5th edition), lipoma vs well-differentiated liposarcoma. Imaging Characteristics of Deep-Seated Lipomatous Tumors: Intramuscular Lipoma, Intermuscular Lipoma, and Lipoma-Like Liposarcoma. Superficial soft-tissue masses can generally be categorized as mesenchymal tumors, skin appendage lesions, metastatic tumors, other tumors and tumorlike lesions, or inflammatory lesions. Lipomas are benign fatty tumors. Lipoma. also what is a heterogenous nodule with tiny cystic spaces, it measures 0.7cm? Your privacy choices/Manage cookies we use in the preference centre. If encapsulated, the capsule may be difficult to identify on ultrasound 5. Lymphocytic mastopathy is a perivascular and perilobular inflammatory process of the breast parenchyma incited by the infiltration of lymphocytes [21,22,23,24]. Therefore, evaluation of sampling adequacy and establishing radiologic-pathologic correlation in these cases is of utmost importance. Figure 2. Staging and histology help to determine whether and what type of surgery and adjuvant radiation or chemotherapy are employed. The most common sites of metastasis are the lymph nodes and lungs. A clinicopathologic review. Reference article, Radiopaedia.org (Accessed on 28 Jun 2023) https://doi.org/10.53347/rID-7654, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":7654,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/lipoma/questions/2578?lang=us"}. Tubular adenoma. In other cases, ultrasound shows only parenchymal distortion with increased shadowing, without a discrete mass (Fig. Inampudi P, Jacobson J, Fessell D et al. The manuscript was edited by Sarah Bronson, ELS, of the Research Medical Library at The University of Texas MD Anderson Cancer Center. The patient underwent three core needle breast biopsies of the mass in the left breast over the span of a month, and a skin punch biopsy. Breast ultrasonography (US) is recognized as a useful diagnostic tool for palpable or nonpalpable breast masses, but isoechoic lesions surrounded by fat can be a challenge for radiologists and can result in false-negative interpretations and a delayed diagnosis of breast cancer. Several less common benign lipomatous masses deserve brief comment. Int J Surg Pathol 20(1):5458, Ibrahim RE, Sciotto CG, Weidner N (1989) Pseudoangiomatous hyperplasia of mammary stroma. Guirguis, M.S., Adrada, B., Santiago, L. et al. It is important to note that stromal fibrosis can be seen in the setting of malignancy and has a reported upgrade rate to malignancy of 7% [35]. How can you tell if a thyroid nodule is malignant? It can, however, mimic malignancy when presenting with suspicious features such as an irregular mass or focal areas of shadowing without a mass (Fig. Ultrasonography can be used to assess size, depth, solid or cystic nature, and associated vasculature. Core needle biopsy showed PASH, Suspicious presentation of pseudoangiomatous stromal hyperplasia. The masses can demonstrate variable shapes and kinetics. isoechoic, i.e. While a complete review of interventional techniques as they relate to soft tissue masses is beyond the scope of this chapter, several general points deserve emphasis. Diabetic mastopathy. Associated skin thickening and edema have also been described [11]. Insights Imaging 12, 53 (2021). Elastofibroma dorsi is a benign fibroelastic pseudotumor, believed to result from friction between the scapula and chest wall. Radiology 198(1):117120, Solomou E, Kraniotis P, Patriarcheas G (2012) A case of a giant pseudoangiomatous stromal hyperplasia of the breast: magnetic resonance imaging findings. Do not biopsy a soft tissue mass without first discussing the needle approach with the surgical oncologist. Created for people with ongoing healthcare needs but benefits everyone. PubMed Central Google Scholar, Jagannathan DM (2015) Benign granular-cell tumor of the breast: case report and literature review. By using this website, you agree to our A 47-year-old premenopausal woman was referred to our hospital with a 2 years history of mass and distortion of her left breast and with recent worsening of her symptoms. The purpose of this review is to illustrate the wide spectrum of imaging features that can be associated with benign breast diseases with an emphasis on the suspicious imaging findings associated with these benign conditions that can mimic cancer. On MRI, a mass with persistent or washout kinetics is usually seen [78]. Breast Imaging Department, MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1350, Houston, TX, 77030-4009, USA, Mary S. Guirguis,Beatriz Adrada,Lumarie Santiago,Rosalind Candelaria&Elsa Arribas, You can also search for this author in T1weighted axial delayed post-contrast (d) and sagittal subtraction (e) post-contrast MRI shows diffuse skin thickening (solid arrow) and trabecular thickening with heterogenous enhancement involving the left superior breast (dashed arrows). Privacy The diagnosis of prostatic carcinoma is most commonly made today by transrectal ultrasound guided needle biopsy. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Corresponding T2 hyperintense cystic components with slit-like spaces (arrow) are identified (g), which favors PASH when present. Calcification may be present in up to 11% of cases, although more commonly associated with well-differentiated liposarcoma 5. Primary malignant tumors hepatocellular carcinoma (HCC) 80-90% AJR Am J Roentgenol 173(2):317320, Yilmaz E, Lebe B, Usal C, Balci P (2001) Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Malignant granular cell tumors occur in 1% of these cases [77]. Ultrasound is used to diagnose the presence and monitor the growth of fibroids: uncomplicated leiomyomas are usually hypoechoic, but can be isoechoic, or even hyperechoic compared to normal myometrium . {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Ranchod A, Niknejad M, et al. The purpose of this review is to illustrate the wide range of suspicious mammographic, sonographic, and magnetic resonance imaging (MRI) features associated with benign breast diseases. Large lipomas may be appreciated as a region of low density exerting mass effect. Spot cradiocaudal and lateral mammogram (a, b) shows a high-density irregular mass (solid arrow), adjacent to an incidental oil cyst (dotted arrow). Short-term follow-up is recommended to ensure stability [34,35,36]. The etiology of lipomas is unknown 10. Characteristically benign features of fat necrosis on MRI include one or more fat-containing masses, which demonstrate T1 hyperintensity on non-fat supresed T1 sequences with corresponding drop in signal on fat-suppressed T1 and T2 sequences. Transverse grayscale (d) ultrasound reveals a corresponding oval isoechoic circumscribed mass. In cases of well-sampled architectural distortion, a short-term follow-up is recommended. Mammographically, a hamartoma has a characteristic benign appearance of a fat-containing circumscribed mass. Contrast-enhanced ultrasound images. Additional treatment options include non-steroidal anti-inflammatory drugs, chemotherapeutic agents, hormonal therapy, and radiation treatment [71, 72]. Ultrasound Evaluation of the Ovaries Outline Normal and Inconsequential Findings, 920 Ovarian Cysts With Typical Benign Features, 920 Simple Cysts, 921 Hemorrhagic Cysts, 921 Endometriomas, 922 Mature Cystic Teratomas, 923 Ovarian Cysts With Typical Malignant Features, 924 Ovarian Cysts With Indeterminate Features, 925 Solid Ovarian Masses, 926 Axial PET/CT (f) shows diffuse fluorodeoxyglucose avidity involving the left breast (arrow). Jamshid Tehranzadeh. In one study, PASH was seen in up to 23% of biopsied cases which reflects its wide spectrum of imaging findings [47]. Inflammatory breast cancer should be strongly considered in patients with breast erythema and swelling in the absence of an abscess on ultrasound evaluation, especially in older non-lactating patients and in patients who are at increased risk of breast cancer. Reactive lymphadenopathy may also be present (Fig. They are round, firm, smooth, discrete masses measuring 0.5-5 cm in diameter that are usually asymptomatic and slow growing. A 14-year-old presented with unilateral breast enlargement. Any fatty tumor deeper than the subcutaneous tissues may be a liposarcoma and warrants MRI evaluation. Stromal fibrosis. Again, areas of calcification may be present although are more frequently associated with well-differentiated liposarcoma 5.

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