Korean J Radiol.  2015 Dec;16(6):1266-1275. 10.3348/kjr.2015.16.6.1266.

Are Irregular Hypoechoic Breast Masses on Ultrasound Always Malignancies?: A Pictorial Essay

• Kim YR
• Kim HS
• Kim HW

• KMID: 2344281
• DOI: http://doi.org/10.3348/kjr.2015.16.6.1266

Abstract

Irregular hypoechoic masses in the breast do not always indicate malignancies. Many benign breast diseases present with irregular hypoechoic masses that can mimic carcinoma on ultrasonography. Some of these diseases such as inflammation and trauma-related breast lesions could be suspected from a patient's symptoms and personal history. Careful ultrasonographic examination and biopsy could help to differentiate these from malignancies.

Keyword

Breast; Ultrasonography; Neoplasm

MeSH Terms

Abscess/ultrasonography
Breast Diseases/pathology
Breast Neoplasms/pathology/*ultrasonography
Carcinoma/pathology/ultrasonography
Female
Fibroadenoma/pathology/ultrasonography
Fibrocystic Breast Disease/pathology/ultrasonography
Granulomatous Mastitis/pathology/ultrasonography
Humans
Ultrasonography, Mammary

Figure

• 

  Fig. 1 Foreign body reaction in 61-year-old woman with history of breast augmentation and removal (material: unknown). A. Transverse ultrasonography image shows irregular spiculated hypoechoic mass with posterior shadowing. B. Left craniocaudal mammogram shows irregular obscured hyperdense mass with overlying skin thickening (arrow) in left breast lower inner quadrant.

• 

  Fig. 2 Fat necrosis in 39-year-old woman without trauma history. A. Transverse ultrasonography (US) shows irregular hypoechoic mass in her left breast. Lesion measured 2.24 cm in diameter. Pathologically, necrosis was confirmed by US-guided core needle biopsy. B. Follow-up US image after 3 years demonstrates decrease in lesion size to 1.67 cm with increased posterior acoustic shadowing.

• 

  Fig. 3 43-year-old woman with fibrotic scar. Initially, she had left breast lesion that was confirmed as fibrocystic change with stromal fibrosis on excisional biopsy (not shown). A. After 5 years of excisional biopsy, lesion shows irregular hypoechoic mass with posterior acoustic shadowing on transverse ultrasonography. Fibrotic nodule with dystrophic calcification was proven from repeated biopsy. B. Transverse ultrasonography image after 7 years shows decreased size of the lesion.

• 

  Fig. 4 Right breast abscess in 36-year-old woman. A. Transverse ultrasonography (US) image shows irregular hypoechoic mass with inner mixed echogenicity in her right breast. B. Increased vascularity is seen on color Doppler US. Acute and chronic inflammation were confirmed by US-guided core needle biopsy. C. After 13 months, transverse US image reveals abscess with fistula formation.

• 

  Fig. 5 5. Granulomatous lobular mastitis in 38-year-old woman presenting as painful mass in left breast. A. Transverse ultrasonography image shows irregular hypoechoic lesion. B. Photomicrograph (hematoxylin and eosin stain, × 100) demonstrates granulomatous inflammation that is centered on lobules with lymphocytes, plasma cells, epithelioid histiocytes, and multinucleated giant cells.

• 

  Fig. 6 Diabetic mastopathy in 44-year-old woman with long-standing type 2 diabetes mellitus. A. Initial transverse ultrasonography image shows irregular spiculated hypoechoic masses with marked posterior shadowing in right breast. B. Photomicrography (hematoxylin and eosin stain, × 100) demonstrates band-like keloid fibrosis with periductal inflammation. After 2 years, lesions remain unchanged on follow-up image (not shown).

• 

  Fig. 7 Sclerosing adenosis in 60-year-old woman. A. Transeverse ultrasonography image shows nonparallel irregular hypoechoic mass. B. Craniocaudal mammogram shows irregular obscured hyperdense mass in her right breast. C. Lesion was proven to be sclerosing adenosis on pathologic exam, showing lobulocentric and swirling architecture of proliferating acini with maintenance of normal epithelial and myoepithelial cells (hematoxylin and eosin stain, × 100).

• 

  Fig. 8 40-year-old woman with apocrine metaplasia. A. Transverse ultrasonography image shows irregular hypoechoic mass with angular margin in her right breast. B. Apocrine metaplasia was reveled from core biopsy (hematoxylin and eosin stain, × 400).

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  Fig. 9 Fibrocystic change in 47-year-old woman. A. Irregular microlobulating hypoechoic mass with posterior shadowing was seen in her left breast on transverse ultrasonography. Inner hyperechoic foci in this lesion suggest calcifications. B. On elastography, lesion demonstrates elasticity score 2.

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  Fig. 10 Fibroadenoma in 45-year-old woman. A. Transverse ultrasonography image shows irregular hypoechoic mass with mild posterior shadowing in right breast. B. Elastogram demonstrates elasticity score 2. Dense collagenous fibroadenoma was proven by excision biopsy.

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  Fig. 11 Intraductal papilloma in 44-year-old woman. Transverse ultrasonography image demonstrates irregular hypoechoic mass in right breast.

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  Fig. 12 Tubular adenoma in 43-year-old woman. A. Transverse ultrasonography image shows irregular hypoechoic mass in her right breast. B. On histologic examination, closely packed small tubules are seen with lining of epithelial cells surrounded by myoepithelial layer (hematoxylin and eosin stain, × 100).

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