Investig Magn Reson Imaging.  2016 Mar;20(1):9-26. 10.13104/imri.2016.20.1.9.

Imaging and Pathologic Characterization of the Skin Thickening or Enhancement under the Breast MRI

• Lee EJ
• Han SH
• Kang BJ
• Kim SH

• KMID: 2161366
• DOI: http://doi.org/10.13104/imri.2016.20.1.9

Abstract

The purpose of this paper is to show the radiologic features of various lesions appearing as skin thickening or enhancement under the breast MRI. And histopathologic results of the skin lesions were correlated. Radiologist must be familiar with normal appearance of the breast skin under the MRI and a wide variety of conditions may affect the skin of the breast.

Keyword

Breast/pathology; Female; Magnetic resonance imaging; Skin/pathology; Skin neoplasms/pathology

MeSH Terms

Breast*
Female
Humans
Magnetic Resonance Imaging*
Skin*

Figure

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  Fig. 1 Normal breast. (a) Diagram of skin. (b) On axial subtraction breast MRI obtained after administration of gadolinium contrast material shows normal skin with mild and smooth enhancement.

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  Fig. 2 A 46-year-old woman with inflammatory caner involving left breast underwent breast MRI and PET-CT. (a) On axial breast MRI, diffuse heterogeneous nonmass enhancement and diffuse skin thickening with enhancement at left breast is seen. There is irregular enhancement of the pectoralis muscle suggesting invasion. The kinetic curve of skin shows persistent enhancement pattern. (b) On PET-CT, huge mass with intense FDG uptake is seen in left breast (SUVmax 10.1) and diffuse and mild FDG uptake is also seen on breast skin (SUVmax 4.3).

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  Fig. 3 A 39-year-old woman, underwent excision of florid ductal hyperplasia, 9 years before. There was thickening at the skin layer of excision site, and the punch biopsy revealed invasive ductal cancer. (a, b) On axial and sagittal breast MRI, irregular enhancing mass with direct skin invasion is seen. Focal skin thickening with enhancement is clearly seen. (c, d) On right mediolateral view of mammography and US, mass with direct skin invasion (arrows) is also seen.

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  Fig. 4 A 50-year-old woman with invasive ductal cancer involving left breast underwent breast MRI and PET-CT. (a, b) On axial breast MRI, irregular and huge infiltrative enhancing mass with direct skin invasion and enhancement is seen. Nipple and areolar complex is also involved. Skin thickening and enhancement is diffuse, over third of breast skin is involved. (c) On PET-CT image, the mass with FDG uptake is seen (SUVmax 18.4) and diffuse and mild FDG uptake is seen on overlying skin.

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  Fig. 5 A 62-year-old woman with mixed invasive ductal and mucinous cancer involving left breast underwent breast MRI and PET-CT. (a) On axial breast MRI, multiple conglomerated masses at upper outer quadrant of left breast and multiple skin nodules are clearly seen. Kinetic curve of skin nodules shows fast rise and delayed plateau pattern. (b) On PET-CT image, the mass with FDG uptake (SUVmax 8.8) is seen at left breast. And a few skin nodules with mild FDG uptake (arrows) is also seen.

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  Fig. 6 A 41-year-old woman, who was detected breast cancer because of palpable mass with skin ulceration. (a, b) On axial breast MRI, irregular enhancing mass with direct skin invasion and enhancement is seen. And defect of overlying skin is clearly seen, which is considered T4b stage.

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  Fig. 7 A 70-year-old woman with invasive lobular cancer involving right breast underwent breast MRI. (a, b) On axial breast MRI, segmental clumped nonmass enhancement is seen at upper portion of right breast. Diffuse skin thickening and enhancement is seen in right breast. (c) On clinical photography, multiple ipsilateral satellite skin nodules are seen, which is correlated with MRI detected skin thickening. The patient underwent punch biopsy of skin nodules, the pathologic result was poorly differentiated cancer originated breast cancer.

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  Fig. 8 A 46-year-old woman who underwent wide excision of right breast 13 months before due to invasive ductal cancer. She complained newly developed skin nodules and underwent punch biopsy for them. Pathology revealed metastatic cancer. (a, b) On axial breast MRI, multifocal irregular enhancing masses (open arrows) surrounding postoperative hematoma in right breast, suggesting recurrent tumor. The masses at anterior portion of the hematoma directly invades of skin. And multiple skin nodules with diffuse skin thickening (arrows) are clearly seen. (c) On PET-CT, the skin thickening and skin nodules show FDG uptake (SUVmax 15.7). (d) On clinical photograph of right breast, focal skin thickening and erythema around the nipple is correlated with direct skin invasion of recurrent tumor. And several skin nodules at mid inner portion of breast are correlated with nodular skin thickening on breast MRI.

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  Fig. 9 A 56-year-old woman, who underwent chemotherapy due to advanced gastric cancer, complained of swelling and erythema of left breast. She underwent punch biopsy of the skin lesion and pathologic result was metastatic cancer. (a) On axial breast MRI, irregular heterogeneous enhancing mass with skin thickening and enhancement on left breast is evident. These findings mimic inflammatory breast cancer. (b) On clinical photography of left breast, breast swelling and erythema around the nipple is correlated with skin invasion of metastatic tumor.

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  Fig. 10 A 14-year-old girl visited the out-patient clinic for evaluation of pain and palpable mass on her left breast. She underwent core needle biopsy and pathologic result was primary cutaneous extranodal NK/T cell lymphoma. (a, b) On axial and sagittal breast MRI, irregular heterogeneous enhancing mass with skin thickening and enhancement on left breast is evident. (c) Maximal intensity projection image shows mass with skin invasion clearly. (d) On US image, irregular hyperechoic mass with indistinct margin at left breast was evident.

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  Fig. 11 A 53-year-old woman visited outpatient clinic for evaluation of palpable masses on both breasts. She underwent core needle biopsy and pathologic result was primary breast lymphoma, diffuse large B cell lymphoma. (a) On axial breast MRI, huge irregular enhancing masses at both breasts with diffuse enhancing skin thickening are evident. (b) On US image of left breast, diffuse skin thickening and huge irregular heterogeneous echoic mass are also seen.

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  Fig. 12 A 40-year-old woman visited outpatient clinic because of pain, erythema and edema on her left breast. She underwent core needle biopsy for left breast, pathologic result was acute and chronic mastitis with microabscess formation and vague granulomas with multinucleated giant cells. (a) On axial breast MRI, diffuse skin thickening with enhancement is seen on her left breast. Diffuse heterogeneous enhancement with trabecular thickening on left breast consistent with acute mastitis. (b) On US image, insinuating irregular hypoechoic lesion with increased echogenicity of subcutaneous fat layer and overlying diffuse skin thickening are seen.

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  Fig. 13 A 54-year-old woman, who underwent mammoplasty with saline bag, visited outpatient clinic because of pain, erythema and pus drainage on her left breast. (a, b) On axial and sagittal breast MRI, focal skin thickening with fistula tract (arrows) is seen on her left breast. (c) On clinical photography, erythema with two, fistula tracts are seen on her left breast, which is consistent with MRI finding.

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  Fig. 14 A 33-year-old woman visited outpatient clinic because of pain and swelling after autologous fat injection on her breasts. She underwent debridement and curettage of left breast. (a, b) On axial and sagittal breast MRI, ill-defined soft tissue infiltration with enhancement along the retromammary space at left breast is seen, which is suggestive of inflammation with abscess formation. Diffuse skin thickening with enhancement and dark signal void of air is clearly seen.

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  Fig. 15 A 41-year-old woman, who suffered from recurrent erythema and painful swelling on her breast, visited outpatient clinic. She underwent breast core needle biopsy and MRI. Pathologic result was chronic lobular granulomatous mastitis. (a, b) On axial breast MRI, clustered ring pattern of nonmass enhancement at left breast peripheral portion is seen with diffuse skin thickening and enhancement (arrow). The findings are consistent with microabscess. (c) On sagittal breast MRI, mild skin retraction abutting to microabscess is clearly seen (arrow).

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  Fig. 16 A 56-year-old woman, who was diagnosed ovarian cancer with metastatic cancer in left axilla, underwent breast MRI. (a, b) On axial T2 and T1 weighted breast MRI, diffuse skin and trabecular thickening of left breast are clearly seen. (c) On axial MRI for axilla, multiple conglomerated metastatic lymph nodes (arrow) are seen. The findings are consistent with obstructive edema due to blocked lymphatics or vein occlusion.

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  Fig. 17 A 42-year-old woman underwent wide excision of left breast due to invasive ductal cancer. She underwent breast MRI annually after the operation. (a) On axial breast MRI after operation, parenchymal defect with architectural distortion at left breast is seen. Focal skin thickening and enhancement (arrows) is also evident, which is consistent with postoperative and postradiation change. (b) After four years from operation, the skin thickening and enhancement are regressed.

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  Fig. 18 A 58-year-old woman, who was diagnosed breast cancer 2 years before but refused any treatment at that time, visits outpatient clinic for control growing mass at breast. She underwent combined chemotherapy and radiation therapy on her right breast. During the radiation therapy, she suffered from radiation ulcer. (a) On axial breast MRI nonmass enhancement at outer portion of right breast and diffuse skin thickening with enhancement is seen. (b, c) On axial and sagittal breast MRI, skin defect (arrows) on diffusely thickened breast skin thickening is clearly seen, which is radiation ulcer.

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  Fig. 19 A 59-year-old woman, who underwent HIFU for treatment of left breast cancer, visited our hospital for evaluation of treatment response. Her skin on breast was burned during the High-intensity focused ultrasound. (a) On axial breast MRI, focal skin thickening with enhancement on her left breast is seen (arrows). (b) On US image, skin thickening overlying irregular hypoechoic lesion (ablated mass) is clearly seen.

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  Fig. 20 A 47-year-old woman underwent modified radical mastectomy with immediate breast reconstruction with contralateral free DIEP flap coverage due to breast cancer. (a, b) On axial breast MRI, diffuse skin thickening and fat necrosis on reconstructed left breast is evident. (c) On US image, diffuse skin thickening and fat necrosis in reconstructed breast is also seen clearly.

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  Fig. 21 A 71-year-old woman, who underwent passenger's traffic accident, visited outpatient clinic for evaluation of palpable mass on her left breast. She underwent core needle biopsy for left breast, pathologic result was hematoma formation and fat necrosis due to seat belt injury. (a-c) On axial and sagittal breast MRI, nonenhancing mass at left breast upper portion is seen, suggesting hematoma with fat necrosis. Focal skin thickening with retraction (arrows) and minimal trabecular thickening are also evident. (d) On axial T2 image, high signal intensity hematoma and edema are seen in left breast.

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