Image of the Month—Quiz Case

Fernando Hernanz
2007 Archives of Surgery  
A 26-YEAR-OLD WHITE WOMAN WITHOUT RISK factors for breast cancer had progressive enlargement of her left breast. There were no others symptoms. Physical examination revealed a large, painless, rubberyfirm, well-circumscribed, lobulated, mobile mass at the outer inferior quadrant of the left breast. There were no palpable axillary lymph nodes. Sonography showed a hypoechogenic mass with a 7.5-cm diameter, well-defined borders, and sporadic cyst areas in the periphery. Mammography showed an
more » ... sed density at the inferior quadrants without calcifications (Figure 1 ). Coreneedle biopsy revealed a benign feature: pseudoangiomatous stromal hyperplasia. Clinical follow-up was recommended. After 10 months, the patient experienced a significant increase in the size of the mass without other associated symptoms. Magnetic resonance imaging was performed. The images confirmed the presence of a well-encapsulated lesion measuring 11 cm in diameter. On T1-weighted imaging, the mass was isointense to the muscle with a homogeneous signal along the mass. On T2-weighted imaging, the mass was isointense to the mammary parenchyma. Contrastenhanced, fat-suppressed fast-spoiled gradient-recalled echo images revealed a type II time-signal intensity curve and an intense ring-enhancing mass with large arteries and veins going to the mass (Figure 2 ). Surgical excision was indicated.
doi:10.1001/archsurg.142.2.201 pmid:17309973 fatcat:lnkul43rvrdd3jqrjpzoglih3u