J Breast Cancer.  2014 Jun;17(2):180-183.

Ductal Carcinoma In Situ Detected by Shear Wave Elastography within a Fibroadenoma

Affiliations
  • 1Department of Radiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. ustabasioglu@hotmail.com
  • 2Department of General Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
  • 3Department of Pathology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Abstract

Fibroadenoma is the most common breast tumor in women. Malignant transformation occurs rarely within fibroadenoma at older ages. Clinicians, radiologists, and pathologists need to be aware of malignant transformation within fibroadenomas. Radiologic studies play an important role in the diagnosis of fibroadenoma; however, radiologic findings are often nonspecific for malignancy and may appear completely benign. We detected an occult ductal carcinoma in situ that originated inside a fibroadenoma by using shear wave elastography. We report shear wave elastography findings of ductal carcinoma in situ within fibroadenoma and discuss the diagnostic role of this modality.

Keyword

Carcinoma; Intraductal; Noninfiltrating; Elasticity imaging techniques; Fibroadenoma

MeSH Terms

Breast Neoplasms
Carcinoma, Intraductal, Noninfiltrating*
Diagnosis
Elasticity Imaging Techniques*
Female
Fibroadenoma*
Humans

Figure

  • Figure 1 Ductal carcinoma in situ within a fibroadenoma in a 30-year-old female. (A) In the gray scale ultrasonography image, there is a bilobulated lesion parallel to the skin surface. Similar heterogenously hypoechoic appearence is seen in the both compound. A few hyperechoic microcalcification are seen also. (B) In the elastography image, 2 mm diameter region of interest calculates maximum elasticity value of lateral portion of mass as 106.1 kPa, on the other hand it was measured 21.8 kPa on medial portion. Note that display was saturated no shear wave elastography artefact was present.

  • Figure 2 Contrast-enhanced magnetic resonance imaging (MRI) of the breast. (A) Breast MRI examination findings of the lesion. Contrast enhanced T1W oblique reformat image shows significantly enhanced lateral portion (arrow) despite the medial portion (arrowhead) of the lesion. (B) Color coding axial image depicts the lesion clearly. (C) Dynamic evaluation is revealed as early intermediate contrast enhancement followed by late phase washout kinetics (type III) in the lateral portion while slow and minimal persistant enhancement kinetics (type I) in the medial portion (not shown).

  • Figure 3 Microscopic findings of ductal carcinoma in situ (DCIS) within fibroadenoma. (A) Magnification view shows DCIS and mild epithelial hyperplasia (arrows) in the fibroadenoma which corresponds to the shear wave elastography and magnetic resonance imaging findings (not all parts of the DCIS portion could be shown due to different slice course) (H&E stain, ×20). (B) Pleomorfic malignant cells are seen within an eosinophilic boundary of basement membran (H&E stain, ×200). (C) This demonstrates the myoepithelial layer around the well defined island of malignant cells with smooth-muscle actin (SMA) immunohistochemistry (×200).


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