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Year : 2005  |  Volume : 15  |  Issue : 1  |  Page : 77-80
Well circumscribed breast carcinoma : Mammographic and sonographic finding report of fine cases


Department of Radio-diagnosis, Gujarat Cancer and Research Institute, B. J. Medical College, Asarwa, Ahmedabad- 380016, India

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Keywords: Well circumscribed breast carcinoma, mammography, sonography

How to cite this article:
Shah N, Patel S B, Goswami K G, Gohil Y M, Shah D M. Well circumscribed breast carcinoma : Mammographic and sonographic finding report of fine cases. Indian J Radiol Imaging 2005;15:77-80

How to cite this URL:
Shah N, Patel S B, Goswami K G, Gohil Y M, Shah D M. Well circumscribed breast carcinoma : Mammographic and sonographic finding report of fine cases. Indian J Radiol Imaging [serial online] 2005 [cited 2014 Nov 22];15:77-80. Available from: http://www.ijri.org/text.asp?2005/15/1/77/28752

   Introduction Top


Circumscribed carcinoma is descriptive term referring to any ductal carcinoma that appear as circumscribed on mammogram. Circumscribed carcinoma is less frequently seen than typical spiculated carcinoma and it include medullary, papillary, mucinous carcinoma as well as invasive ductal carcinoma and some insitu ductal carcinoma. Invasive ductal carcinoma that appear circumscribed may be referred as carcinoma simplex or knobby carcinoma [1].


   Case reports Top


Case 1 :

A 50 year female presented with only palpable lump in right breast, On mammogram well defined soft tissue density lesion with obscured posterior margin noted in right breast retroareolar region .

On compression view, obscuration was due to adjacent breast parenchyma but there was comet-tail like projection arising from posterior margin [Figure - 1]. On sonography the lesion appeared well defined hypoechoic without acoustic shadowing.

Due to comet-like projection and age of patient we advised biopsy and mass turned out to be malignant.

Case 2 :

A 45 year female came for screening mammogram, On left mammogram there was well circumscribed soft tissue density mass with peripherally situated clusters of irregular microcalcification noted in upper inner quadrant [Figure - 2]. On sonography lesion appeared well defined hypoechoic with microcalcification within it .

Because of microcalcification biopsy was advised and lesion turned out to be malignant.

Case 3 :

A 38-year female presented with palpable lump and pain in left breast, On mammogram well circumscribed lobulated soft tissue density mass was noted with ill-defined posterior margin [Figure - 3], which on compression view was not separated from breast parenchyma. On sonography lesion appeared hypoechoic with internal cystic spaces.

Because of lobulation, ill-defined posterior margin on mammogram and cystic spaces on sonography, biopsy was advised and mass turned out to be malignant.

Case 4:

A 40 year female presented with palpable lump in right breast, On mammogram well-circumscribed soft tissue density lesion noted in upper outer quadrant with comet-tail like projection arising from anterior margin and flattening of superior margin [Figure - 4]. On sonography lesion was heterogenous

and show internal cystic spaces [Figure - 5].

Because of flattening of margin and comet-tail projection on mammogram and cystic spaces on sonography, biopsy was advised and lesion turned out to be malignant.

Case 5:

A 35 year female presented with lump in left breast, On mammogram soft tissue density lobulated lesion noted in upper-outer quadrant. One of the margin of lesion was ill-defined [Figure - 6]. On sonography lesion appeared well-defined lobulated and hypoechoic.

Because of lobulation and ill-defined margin, biopsy was advised and lesion turned out to be malignant.


   Discussion Top


The vast majority of circumscribed masses are cysts, fibroadenoma and intramammary lymphnodes, careful mammographic and sonographic evaluation can often reveal typical benign and malignant characteristic so that biopsy or even close follow-up can be advice accordingly.

The likelyhood of malignancy for a completely well-defined circumscribed mass of 1 cm or less is extremely low. Moskowitz found that the probability of cancer, given a completely well-defined mass greater than 1 cm palpable or not, was 2% (12/573). If the mass had partial loss of a border with no spiculation, probability was 5% (15/276) if the clinical feature negative and 11% (13/122) in presence of any localized clinical abnormality[2].

All circumscribed breast masses should be evaluated according to their density, shape, margin, type of calcification, stability of size and multiplicity.

Although appearance of well-circumscribed carcinoma is non-specific, several feature are suggestive. Age of patient usually above 35 year except for medullary carcinoma. On mammogram the perfectly smooth carcinoma is relatively rare but does occur. Usually, one can see the telltale sign that the lesion is not just a benign mass. Such sign include lobulation, a small "comet-tail" like projection

from one of the border, a flattening of one side of the lesion, or very slight irregularity in seemingly smooth lesion, in which compression view is necessary [3]. Compression view is also necessary for evaluation of obscuration of part of margin of lesion and calcification. Obscuration of margin is due to surrounding dense glandular parenchyma or lymphocytic infiltration. The calcification of malignancy

are typically grouped or clustered, pleomorphic, fine and branching, and numerous [4]. On sonography lesion appear as hypoechoic oval or round lesion with varying degree of attenuation usually less than that of spiculated carcinoma, some of lesion show internal cystic spaces [5]. Margin are usually well defined but some of margin are irregular or ill-defined, such a lesion should be suspicious for malignancy.

Finally, although it is not possible to differentiate solid benign masses from well-circumscribed carcinoma, mammographic and sonographic findings described should suggest carcinoma as possible diagnosis.

 
   References Top

1.Stephen A. feig, MD.Breast masses-mammographic and sonographic evalution Radio Clin North Am 30:67-90,1992   Back to cited text no. 1    
2.Moskowitz M. Predictive value of certain Mammographic sign in screening for breast cancer Cancer 51:1007-1011,1983   Back to cited text no. 2    
3.Norman Sadowsky, MD, and Daniel B. Korpan, MD. Breast cancer Radio Clin North Am 21:51-65,1983.  Back to cited text no. 3    
4.Lowerence W. Bassett, MD. Mammographic analysis of calcifications Radio Clin North Am 30:93-105,1992  Back to cited text no. 4    
5.Jack E. Mayer, MD, Elizabeth Amin, MD,Karen K. Lindfors,MD, John C. Lipman, MD, Paul C. Stamper, MD, and David Genest, MD. Medullary cancinoma of breast: Mammographic and US appearance Radiology 170: 79- 82,1989  Back to cited text no. 5    

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Correspondence Address:
N Shah
Department of Radio-diagnosis, Gujarat Cancer and Research Institute, B. J. Medical College, Asarwa, Ahmedabad- 380016
India
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DOI: 10.4103/0971-3026.28752

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]

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