BREASTBREAST

NORMAL ANATOMYNORMAL ANATOMY

The breast consist of three types of tissue:

the skin

subcuteneous adepose tissue and

the functional glandular tissue.

The breast consist of three types of tissue:

the skin

subcuteneous adepose tissue and

the functional glandular tissue.

Centrally, there is the nipple-areolar complex. Collecting duct open onto the tip of the nipple. Centrally, there is the nipple-areolar complex. Collecting duct open onto the tip of the nipple.

There are sebaceous glands within the nipple-areolar complex called

montomery’s gland. Small raised nodular structures called

montomery’s tubercle.

There are sebaceous glands within the nipple-areolar complex called

montomery’s gland. Small raised nodular structures called

montomery’s tubercle.

Deep to nipple-areolar complex, breast is divided into15-25 lobes,each

consisting of a branching duct system leading from the collecting

ducts to the terminal duct lobular units (TDLU), the site of milk

production in lactating breast.

Each duct drains a lobe made up of 20-40 lobules.

Deep to nipple-areolar complex, breast is divided into15-25 lobes,each

consisting of a branching duct system leading from the collecting

ducts to the terminal duct lobular units (TDLU), the site of milk

production in lactating breast.

Each duct drains a lobe made up of 20-40 lobules.

The breast lies on the chest wall on the deep pectoral fascia.

The superficial pectoral fascia envelops the breast.

Suspensory ligaments – Cooper’s ligament – connect the two layers, providing a degree of support to the breast and giving the breast its shape.

The breast lies on the chest wall on the deep pectoral fascia.

The superficial pectoral fascia envelops the breast.

Suspensory ligaments – Cooper’s ligament – connect the two layers, providing a degree of support to the breast and giving the breast its shape.

The number of lobules per lobe varies according to age,

lactation,parity and hormonal status.

At the end of reproductive life there is an increase in amount of

adepose tissue and the main duct system is preserved, considerable

loss of lobular unit.

The number of lobules per lobe varies according to age,

lactation,parity and hormonal status.

At the end of reproductive life there is an increase in amount of

adepose tissue and the main duct system is preserved, considerable

loss of lobular unit.

1. Muscle of the chest

wall.

2. Pectoralis muscles,

these support the

breast.

3. Lobules, the

mammary glands

that produce the

milk.

4. Nipple.

5. Areola.

6. Lactiferous duct,

carry the milk from

the glands to the

nipple.

7. Mammary fat.

8. Chest.

1. Muscle of the chest

wall.

2. Pectoralis muscles,

these support the

breast.

3. Lobules, the

mammary glands

that produce the

milk.

4. Nipple.

5. Areola.

6. Lactiferous duct,

carry the milk from

the glands to the

nipple.

7. Mammary fat.

8. Chest.

BREAST ULTRASOUND TECHNIQUEBREAST ULTRASOUND TECHNIQUE

Dynamically focused phased array, linear array and annular

transducers of 7-10 MHz should be used.

Dynamically focused phased array, linear array and annular

transducers of 7-10 MHz should be used.

The patient is examined in supine oblique position.The patient is examined in supine oblique position.

The side being examined is raised and the arm placed above the head to ensure that the breast tissue is evenly distributed over the chest wall.

The side being examined is raised and the arm placed above the head to ensure that the breast tissue is evenly distributed over the chest wall.

Scanning in the radial and antiradial planes are of value in demonstrating ductal abnormality.Scanning in the radial and antiradial planes are of value in demonstrating ductal abnormality.

INDICATIONS INDICATIONS

Symptomatic breast lumps in women aged less than 35yrs.Symptomatic breast lumps in women aged less than 35yrs.

Breast lump developing during pregnancy and lactationBreast lump developing during pregnancy and lactation

Assessment of mammographic abnormality Assessment of mammographic abnormality

Breast inflammationBreast inflammation

Breast lump in male Breast lump in male

Guidance of needle biopsy or localizationGuidance of needle biopsy or localization

Follow-up of breast cancer treated with adjuvant chemotherapyFollow-up of breast cancer treated with adjuvant chemotherapy

Clinical mass with negative mammogramClinical mass with negative mammogram

The augmented breastThe augmented breast

Sonographic AnatomySonographic Anatomy

The anatomic components of the breast and sorrounding structures

(skin, ducts,adepose tissue, parenchyma, nipple, blood vessels,

retrommary muscles and ribs) have characteristic sonographic features.

The skin complexThe skin complex

Is seen as two thin, echogenic lines demarcating a narrow hypoechoic

band, the dermis.

The normal skin measures up to 0.2 cm in thickness , may be thicker in

the lower breast near the inframammary fold.

Is seen as two thin, echogenic lines demarcating a narrow hypoechoic

band, the dermis.

The normal skin measures up to 0.2 cm in thickness , may be thicker in

the lower breast near the inframammary fold.

Fat lobulesFat lobules

Oval in one plane of view and elongated in the orthogonal plane.

They are hypoechoic relative to the sorrounding glandular tissue and

may have a central echogenic focus of connective tissue.

The subcuteneous fat lobules and those within the breast are usually

larger than fat lobules located in the pectoral area.

Oval in one plane of view and elongated in the orthogonal plane.

They are hypoechoic relative to the sorrounding glandular tissue and

may have a central echogenic focus of connective tissue.

The subcuteneous fat lobules and those within the breast are usually

larger than fat lobules located in the pectoral area.

Breast parenchymaBreast parenchyma

Appears homogeneously echogenic as compared with fat lobules but

may have hypoechoic zones caused by fatty tissue.

Fibroglandular tissue appears echogenic.

Found in pt of all ages, but characteristic of the breasts of very young,

excessive homogenously echogenic tissue.

Appears homogeneously echogenic as compared with fat lobules but

may have hypoechoic zones caused by fatty tissue.

Fibroglandular tissue appears echogenic.

Found in pt of all ages, but characteristic of the breasts of very young,

excessive homogenously echogenic tissue.

Cooper’s ligamentCooper’s ligament

Appears as thin, echogenic arcs. Appears as thin, echogenic arcs.

Terminal duct lobular units( TDLU)Terminal duct lobular units( TDLU)

Many benign ( cysts, adenosis, fibroadenoma) and malignant process

arises from it.

The TDLU may enlarge or involute, reflecting age and physiologic

differences and proliferate in pregnancy.

Hyperplastic TDLU are seen on USG image as hyechoic areas.

Many benign ( cysts, adenosis, fibroadenoma) and malignant process

arises from it.

The TDLU may enlarge or involute, reflecting age and physiologic

differences and proliferate in pregnancy.

Hyperplastic TDLU are seen on USG image as hyechoic areas.

The mammary ductsThe mammary ducts

Visible as tubular structures measures about 0.1cm to 0.8cm in diameter.Visible as tubular structures measures about 0.1cm to 0.8cm in diameter.

The mammary ductsThe mammary ducts

Medium level echogenicity and attenuates sound, resulting posterior

acoustic shadows.

Scanning obliquely behind the nipple or using an offset pad will allow

the area posterior to the nipple to be visualized.

Normal nipple sometimes appear as a well-defined hypoechoic oval area

resembling a superficial adenoma if imaged from an oblique angle.

Medium level echogenicity and attenuates sound, resulting posterior

acoustic shadows.

Scanning obliquely behind the nipple or using an offset pad will allow

the area posterior to the nipple to be visualized.

Normal nipple sometimes appear as a well-defined hypoechoic oval area

resembling a superficial adenoma if imaged from an oblique angle.

Visible as thin lines, usually not seen.

The superficial layer seen below the dermis, the deeper layer lies over

the retromammary fat and pectoralis muscle.

Visible as thin lines, usually not seen.

The superficial layer seen below the dermis, the deeper layer lies over

the retromammary fat and pectoralis muscle.

The fascial envelopeThe fascial envelope

Visualization of the pectoralis muscle assures that the breast

parenchyma has been adequately penetrated at that site.

Visualization of the pectoralis muscle assures that the breast

parenchyma has been adequately penetrated at that site.

Pectoralis musclePectoralis muscle

The ribsThe ribs

Oval, hypoechoic, periodic structures behind the pectoralis muscles.

They attenuate sound, causing a posterior acoustic shadow.

Oval, hypoechoic, periodic structures behind the pectoralis muscles.

They attenuate sound, causing a posterior acoustic shadow.

An ultrasonogram of a normal breast. F, subcutaneous fat; FG, fibroglandular tissue with intervening fatty tissue; P, pectoralis muscle; S, skin. The hypoechoic region beneath the pectoralis muscle represents a rib (arrow).

An ultrasonogram of a normal breast. F, subcutaneous fat; FG, fibroglandular tissue with intervening fatty tissue; P, pectoralis muscle; S, skin. The hypoechoic region beneath the pectoralis muscle represents a rib (arrow).

Breast PathologyBreast Pathology

Cysts Cysts

Benign mass lesionBenign mass lesion

Fibroadenoma and related conditionsFibroadenoma and related conditions

Papilloma Papilloma

Hamartoma Hamartoma

Lipoma Lipoma

Malignant mass lesionMalignant mass lesion

Carcinoma of breastCarcinoma of breast

Inflammations Inflammations

Acute mastitis Acute mastitis

Breast abscess Breast abscess

Mammary duct ectasia

Mammary duct ectasia

Tramatic fat necrosis

Tramatic fat necrosis

Fibrocystic diseaseFibrocystic disease

Simple fibrocystic changes

Simple fibrocystic changes

Epithelial hyperplasia

Epithelial hyperplasia

Simple Breast Cyst Simple Breast Cyst

Simple Cyst

anechoic

well-marginated

round, ovoid, or lobulated

solitary or multiple

well-defined posterior wall

acoustic enhancement

Simple Cyst

anechoic

well-marginated

round, ovoid, or lobulated

solitary or multiple

well-defined posterior wall

acoustic enhancement

Breast cyst Breast cyst

Ultrasound Demonstrates Cysts in BreastUltrasound Demonstrates Cysts in Breast

Complex Cysts

These cysts may contain internal echoes, as a result of hemorrhage or infection, and may demonstrate wall thickness. These cysts may contain internal echoes, as a result of hemorrhage or infection, and may demonstrate wall thickness.

Ultrasound image showing adjacent breast masses:one a simple cyst, the other debris filled. Ultrasound image showing adjacent breast masses:one a simple cyst, the other debris filled.

A complex cyst shows low-level internal echoes/ fluid-debris level. These internal echoes may be caused by floating cholesteral crystals, pus, blood, or milk of calcium crystals.

A complex cyst shows low-level internal echoes/ fluid-debris level. These internal echoes may be caused by floating cholesteral crystals, pus, blood, or milk of calcium crystals.

Figures 5 and 6 demonstrate complex cystic areas with an internal soft tissue component. Biopsy was performed on both of these lesions, confirming the diagnosis of benign intracystic papilloma. These lesions occur from a growth within a duct that eventually results in ductal obstruction and cyst formation. 

Figures 5 and 6 demonstrate complex cystic areas with an internal soft tissue component. Biopsy was performed on both of these lesions, confirming the diagnosis of benign intracystic papilloma. These lesions occur from a growth within a duct that eventually results in ductal obstruction and cyst formation. 

Ultrasonogram demonstrates 2 ovoid, smooth, thin-walled, anechoic masses with acoustic enhancement. The larger is anechoic, compatible with a simple cyst (see arrow). The smaller contains some internal echoes, although it also was shown to represent a cyst.

Ultrasonogram demonstrates 2 ovoid, smooth, thin-walled, anechoic masses with acoustic enhancement. The larger is anechoic, compatible with a simple cyst (see arrow). The smaller contains some internal echoes, although it also was shown to represent a cyst.

Fibroadenoma.  Fibroadenoma. 

A fibroadenoma is the most common benign tumor in women of child-

bearing age.

The mass presents as a firm, smooth, oval shaped, well-marginated

(sometimes lobulated), freely movable mass.

It is rarely tender or painful. The size is under 5cm, the number is

multiple in 10-20% and bilateral in 4%.

Calcifications may occur.

A fibroadenoma is the most common benign tumor in women of child-

bearing age.

The mass presents as a firm, smooth, oval shaped, well-marginated

(sometimes lobulated), freely movable mass.

It is rarely tender or painful. The size is under 5cm, the number is

multiple in 10-20% and bilateral in 4%.

Calcifications may occur.

On ultrasoundOn ultrasound

The texture is usually homogenous and hypoechoic with low-level

echoes.

In a small number of patients, the mass may appear complex,

hyperechoic, or isoechoic.

The solid nature of the mass prevents acoustic transmission.

There may be few well-circumscribed lobulations.

Growth in the horizontal plane may be greater than that in the

vertical

The texture is usually homogenous and hypoechoic with low-level

echoes.

In a small number of patients, the mass may appear complex,

hyperechoic, or isoechoic.

The solid nature of the mass prevents acoustic transmission.

There may be few well-circumscribed lobulations.

Growth in the horizontal plane may be greater than that in the

vertical

Fibroadenoma.  Fibroadenoma. 

Breast Fibroadenomas Breast Fibroadenomas

Breast Abscess Breast Abscess

When viewed by ultrasound,

abscesses commonly have

thick walls and are oval or

irregular in shape.

They typically contain

cystic and solid

components, resulting in a

complex appearance, and

demonstrate acoustic

enhancement

When viewed by ultrasound,

abscesses commonly have

thick walls and are oval or

irregular in shape.

They typically contain

cystic and solid

components, resulting in a

complex appearance, and

demonstrate acoustic

enhancement

Breast Abscess: Breast Abscess:

Ultrasound images of the breast

reveal a rounded, almost anechoic

lesion with posterior acoustic

enhancement.

The lesion measures 2 cms. and

has irregular but well defined

walls.

No internal septae are present.

Color Doppler images suggest

some increase in vascularity along

the rim of the lesion.

These ultrasound findings

suggest an abscess of the breast.

Ultrasound images of the breast

reveal a rounded, almost anechoic

lesion with posterior acoustic

enhancement.

The lesion measures 2 cms. and

has irregular but well defined

walls.

No internal septae are present.

Color Doppler images suggest

some increase in vascularity along

the rim of the lesion.

These ultrasound findings

suggest an abscess of the breast.

Chronic Abscess Of The Breast.  Chronic Abscess Of The Breast. 

Clinical symptoms include

fever, pain, tenderness to

touch, increased white

blood count.

The most common location

is in the central to

subareolar area.

An abscess may range

from somewhat ill-defined

to well-defined, anechoic to

low-level echoes, with

posterior enhancement.

Clinical symptoms include

fever, pain, tenderness to

touch, increased white

blood count.

The most common location

is in the central to

subareolar area.

An abscess may range

from somewhat ill-defined

to well-defined, anechoic to

low-level echoes, with

posterior enhancement.

Sebaceous Cyst Sebaceous Cyst

Sebaceous cysts are formed as a result of obstructed

sebaceous glands or hair follicles.

These cysts contain an oily substance, and are therefore

often characterized by internal echoes that may be seen

on ultrasound.

They are typically located at the inferior and medial breast

margins, or near the axilla.

Sebaceous cysts are formed as a result of obstructed

sebaceous glands or hair follicles.

These cysts contain an oily substance, and are therefore

often characterized by internal echoes that may be seen

on ultrasound.

They are typically located at the inferior and medial breast

margins, or near the axilla.

Mastitis During Breastfeeding Mastitis During Breastfeeding

Edema affects all layers of the breast parenchyma in mastitis.

The skin and subcutaneous fat become thickened and hyperechoic.

In addition, the Cooper's ligaments may become more hypoechoic.

 Hyperemia may also be demonstrated with color Doppler.

Edema affects all layers of the breast parenchyma in mastitis.

The skin and subcutaneous fat become thickened and hyperechoic.

In addition, the Cooper's ligaments may become more hypoechoic.

 Hyperemia may also be demonstrated with color Doppler.

Mastitis is inflammation of the breast. It can be associated with

lactation (puerperal) or other conditions, such as an infected cyst

(nonpuerperal)

Mastitis is inflammation of the breast. It can be associated with

lactation (puerperal) or other conditions, such as an infected cyst

(nonpuerperal)

Ultrasound images of lactating breast: Ultrasound images of lactating breast:

Ultrasound image shows prominent

and dilated mammary ducts in the

lactating breast.

The ducts are seen as tubular

hypoechoic structures, which

widen as they approach the nipple.

Sometimes, it may be possible to

see fat drops within the milk

secretions in the ducts. These

appear as mildly echogenic debris

within the ducts. 

Ultrasound image shows prominent

and dilated mammary ducts in the

lactating breast.

The ducts are seen as tubular

hypoechoic structures, which

widen as they approach the nipple.

Sometimes, it may be possible to

see fat drops within the milk

secretions in the ducts. These

appear as mildly echogenic debris

within the ducts. 

On ultrasound, it appears as hypoechoic to anechoic with ill-

defined margins. Acoustic shadow may or may not be present.

Characteristics of fat necrosis on ultrasound may vary

depending on the lesion; fat necrosis may look like a simple

cyst or anechoic mass with solid components.

On ultrasound, it appears as hypoechoic to anechoic with ill-

defined margins. Acoustic shadow may or may not be present.

Characteristics of fat necrosis on ultrasound may vary

depending on the lesion; fat necrosis may look like a simple

cyst or anechoic mass with solid components.

Fat necrosisFat necrosis

Fat necrosis occurs in a very small percentage of breast

biopsies, post-surgery, or after radiation treatments.

It may be found anywhere however is more common in the

areolar region or near the biopsy site.

The appearance is a firm, slightly fixed mass with skin

retraction in half of the cases.

The mass may show calcifications.

Fat necrosis occurs in a very small percentage of breast

biopsies, post-surgery, or after radiation treatments.

It may be found anywhere however is more common in the

areolar region or near the biopsy site.

The appearance is a firm, slightly fixed mass with skin

retraction in half of the cases.

The mass may show calcifications.

Several lucent nodules are present in the upper outer right breast, with surrounding density, consistent with fat necrosis.

Several lucent nodules are present in the upper outer right breast, with surrounding density, consistent with fat necrosis.

Oil cyst of breast: Oil cyst of breast:

The breast in this patient

showed multiple cystic

lesions on sonography.

Remarkably, there is

acoustic shadowing

posterior to the cyst. Clear

fluid contents are seen

within the cystic lesions.

The breast in this patient

showed multiple cystic

lesions on sonography.

Remarkably, there is

acoustic shadowing

posterior to the cyst. Clear

fluid contents are seen

within the cystic lesions. Calcific oil cysts of the breast Calcific oil cysts of the breast

Oil cysts are produced due to fat necrosis with liquefaction and subsequent cyst formation, usually following trauma. Oil cysts are produced due to fat necrosis with liquefaction and subsequent cyst formation, usually following trauma.

This condition

includes hyperplasia

and hypertrophy of

the glandular

elements within the

breast.

The lobules show an

increase in size and

on ultrasound appear

as isoechoic to mildly

isochoic as compared

with fat. 

This condition

includes hyperplasia

and hypertrophy of

the glandular

elements within the

breast.

The lobules show an

increase in size and

on ultrasound appear

as isoechoic to mildly

isochoic as compared

with fat. 

Adenosis.Adenosis.

This condition is found in 72% of the screening population over

55 years of age.

The cause is an exaggeration of normal cyclical proliferation and

involution of the breast with production and incomplete

absorption of fluid by apocrine cells.

Clinical symptoms include fullness, tenderness, and pain that

varies with the menstrual cycle.

There may be palpable nodules and thickening within the breast.

Fibrocystic ChangesFibrocystic Changes

The cystic changes

include round to ovid

cysts with smooth

margins. They may be

lobulated or

multilocular.

These changes are well

defined on ultrasound.

The cystic changes

include round to ovid

cysts with smooth

margins. They may be

lobulated or

multilocular.

These changes are well

defined on ultrasound.

Galactocele of breast: Galactocele of breast:

Hypoechoic (almost cystic) lesion with through transmission.

Color doppler images of the breast showed no signficant enhancement of vascularity. 

Hypoechoic (almost cystic) lesion with through transmission.

Color doppler images of the breast showed no signficant enhancement of vascularity. 

Galactocele with a fat-fluid level s/o galactocele. The echogenic material is seen to move with change in posture 

Galactocele with a fat-fluid level s/o galactocele. The echogenic material is seen to move with change in posture 

Hypoechoic

Irregularly marginated (especially anterior margin)

Heterogeneous internal echoes

Acoustic shadowing

Hypoechoic

Irregularly marginated (especially anterior margin)

Heterogeneous internal echoes

Acoustic shadowing

Carcinoma of breast: Carcinoma of breast:

Ultrasound Appearance Of Malignant Disease Of The BreastUltrasound Appearance Of Malignant Disease Of The Breast

Noninvasive Breast Cancer. This type of cancer accounts for

15% of all cancers. It occurs when there is a malignant

transformation of epithelial cells lining the mammary ducts and

lobules confined within the boundaries of the basement

membrane. 

Noninvasive Breast Cancer

ductal carcinoma in situ,

lobular carcinoma in situ

intracystic papillary carcinoma in situ.

Noninvasive Breast Cancer. This type of cancer accounts for

15% of all cancers. It occurs when there is a malignant

transformation of epithelial cells lining the mammary ducts and

lobules confined within the boundaries of the basement

membrane. 

Noninvasive Breast Cancer

ductal carcinoma in situ,

lobular carcinoma in situ

intracystic papillary carcinoma in situ.

TypesTypes

Invasive Breast Carcinoma. This type of malignancy accounts for

the majority of breast cancers in 85% of the population. 

Invasive Breast Cancer

Infiltrating/invasive ductal carcinoma (65%)

Invasive lobular carcinoma (8-13%)

Tubular carcinoma (6-8%)

Medullary carcinoma (2%)

Mucinous carcnimoa (2%)

Papillary carcinoma (2-4%)

Invasive Breast Carcinoma. This type of malignancy accounts for

the majority of breast cancers in 85% of the population. 

Invasive Breast Cancer

Infiltrating/invasive ductal carcinoma (65%)

Invasive lobular carcinoma (8-13%)

Tubular carcinoma (6-8%)

Medullary carcinoma (2%)

Mucinous carcnimoa (2%)

Papillary carcinoma (2-4%)

Invasive Ductal Carcinoma Invasive Ductal Carcinoma

Invasive ductal carcinoma is predominantly hypoechoic, but the mass is indistinctly separated from the echogenic halo (arrow) that surrounds it. The halo may or may not contain tumor cells, but two measurements, one of the hypoechoic area alone and a second, the diameter of the hypoechoic component plus the echogenic rim, could be reported.

This is the most common noninvasive carcinoma.

It occurs in postmenapausal women over 55 years old.

The mass may persist for years without a palpable abnormality.

Therefore, when the mass is noted, it is usually large enough to

feel by palpation; nipple discharge may be present as well as

microcalcifications. 

This is the most common noninvasive carcinoma.

It occurs in postmenapausal women over 55 years old.

The mass may persist for years without a palpable abnormality.

Therefore, when the mass is noted, it is usually large enough to

feel by palpation; nipple discharge may be present as well as

microcalcifications. 

Ductal carcinoma in situDuctal carcinoma in situ

This disease arises in the epithelium of the blunt ducts of the

mammary lobules.

It comprises about one fourth of the noninvasive cancers, with an

increased incidence during the reproductive years.

It may present as a noncalcified mass, or with calcifications and a

palpable mass.

It may also occur on the contralateral breast.

This disease arises in the epithelium of the blunt ducts of the

mammary lobules.

It comprises about one fourth of the noninvasive cancers, with an

increased incidence during the reproductive years.

It may present as a noncalcified mass, or with calcifications and a

palpable mass.

It may also occur on the contralateral breast.

Lobular carcinoma in situLobular carcinoma in situ

This cancer is rare and affects middle aged females with the

average age 51 years.

The mass is well circumscribed and freely moveable.

Bloody fluid is obtained with aspiration.

Ultrasound findings show a solid well-defined mass.

This cancer is rare and affects middle aged females with the

average age 51 years.

The mass is well circumscribed and freely moveable.

Bloody fluid is obtained with aspiration.

Ultrasound findings show a solid well-defined mass.

Intracystic papillary carcinoma in situ.Intracystic papillary carcinoma in situ.

This is the second most common type of breast cancer (30-50%).

At least 30-50% of patients will develop a second primary in the same

or opposite breast within 20 years.

It is the most frequently missed cancer as it is difficult to detect on

mammography and by clinical examination.

Clinical findings may show architectural distortion, thickening of

fibrous septa, spiculations, poorly defined borders,

microcalcifications, and skin/ nipple retraction.

This is the second most common type of breast cancer (30-50%).

At least 30-50% of patients will develop a second primary in the same

or opposite breast within 20 years.

It is the most frequently missed cancer as it is difficult to detect on

mammography and by clinical examination.

Clinical findings may show architectural distortion, thickening of

fibrous septa, spiculations, poorly defined borders,

microcalcifications, and skin/ nipple retraction.

Invasive lobular carcinomaInvasive lobular carcinoma

This cancer is a well differentiated form of ductal carcinoma

occurring in the middle aged female with a positive family history.

It is associated with lobular carcinoma in situ in 40% of patients.

This cancer is a well differentiated form of ductal carcinoma

occurring in the middle aged female with a positive family history.

It is associated with lobular carcinoma in situ in 40% of patients.

This is the fastest growing breast carcinoma seen in the middle aged

female.

The mass is well circumscribed with a nodular architecture and

lobulated contour.

In larger tumors, a central necrosis may be seen.

On ultrasound the mass appears hypoechoic with some through

transmission if there is central cystic necrosis and indeterminate

borders.

This is the fastest growing breast carcinoma seen in the middle aged

female.

The mass is well circumscribed with a nodular architecture and

lobulated contour.

In larger tumors, a central necrosis may be seen.

On ultrasound the mass appears hypoechoic with some through

transmission if there is central cystic necrosis and indeterminate

borders.

Tubular carcinoma.Tubular carcinoma.

Medullary carcinoma.Medullary carcinoma.

This rare tumor appears in older women and shows a slow growth

pattern. 

This rare tumor appears in older women and shows a slow growth

pattern. 

Mucinous colloid carcinomaMucinous colloid carcinoma

Most women present with a palpable mass with a quarter showing

nipple discharge.

The mass is usually solitary with well-circumscribed borders.

More than half will show microcalcifications.

There is a 90% five year survival rate after a mastectomy

Most women present with a palpable mass with a quarter showing

nipple discharge.

The mass is usually solitary with well-circumscribed borders.

More than half will show microcalcifications.

There is a 90% five year survival rate after a mastectomy

Papillary carcinomaPapillary carcinoma

Carcinoma of breast: Carcinoma of breast:

These ultrasound images reveal a hypoechoic, poorly defined,

irregular mass in the breast. There is also evidence of acoustic

shadowing posteriorly. These findings on sonography suggest

malignant mass of the breast.

These ultrasound images reveal a hypoechoic, poorly defined,

irregular mass in the breast. There is also evidence of acoustic

shadowing posteriorly. These findings on sonography suggest

malignant mass of the breast.

Left breast ultrasound shows a rounded, hypoechoic solid lesion with the borders ill-defined in part. Left breast ultrasound shows a rounded, hypoechoic solid lesion with the borders ill-defined in part.

Carcinoma of breast: Carcinoma of breast:

Carcinoma of breast: Carcinoma of breast:

Left axilla. Left axilla. Breast ultrasound Breast ultrasound

Gynecomastia in a Young Male Gynecomastia in a Young Male

Gynecomastia is a condition

that results in male breast

enlargement due to an

abnormal proliferation of

ductal tissue, glandular tissue,

and stroma.

Increased subcutaneous fat

may also be noted. 

Gynecomastia is a condition

that results in male breast

enlargement due to an

abnormal proliferation of

ductal tissue, glandular tissue,

and stroma.

Increased subcutaneous fat

may also be noted. 

Ultrasonogram of late gynecomastia.

Development of fibrosis in late

gynecomastia leads to an increase in

echogenicity of the breast parenchyma

Ultrasonogram of late gynecomastia.

Development of fibrosis in late

gynecomastia leads to an increase in

echogenicity of the breast parenchyma

Breast ultrasound showed in the right retroareolar region, a solid mass of 3 × 1 cm with homogeneous echostructure and well-defined margins.

Breast ultrasound showed in the right retroareolar region, a solid mass of 3 × 1 cm with homogeneous echostructure and well-defined margins.

Solitary fibrous tumor of the male breast Solitary fibrous tumor of the male breast

This lesion has a variable

appearance; it may be elongated

and filled with fluid.

Old cellular debris may appear as

hypoechoic on ultrasound,

however the "tubular"appearance is

more typical.

This lesion has a variable

appearance; it may be elongated

and filled with fluid.

Old cellular debris may appear as

hypoechoic on ultrasound,

however the "tubular"appearance is

more typical.

Duct EctasiaDuct Ectasia

This lesion is rarely seen; the mean age is 45 years.

The mass is soft and nonpalpable in 60% of patients.

It appears in the retroareolar and upper outer quadrant in 65% of

patients.

A hamartoma is round or ovoid, well-circumscribed, and less

than 3 cm in size. It may contain calcifications.

This lesion is rarely seen; the mean age is 45 years.

The mass is soft and nonpalpable in 60% of patients.

It appears in the retroareolar and upper outer quadrant in 65% of

patients.

A hamartoma is round or ovoid, well-circumscribed, and less

than 3 cm in size. It may contain calcifications.

HamartomaHamartoma

Ultrasound findings have shown a harmartoma to contain

fibrous elements that may be specular in their reflections with

hypoechoic texture. The mass is encapsulated and distinct from

surround tissue.

Ultrasound findings have shown a harmartoma to contain

fibrous elements that may be specular in their reflections with

hypoechoic texture. The mass is encapsulated and distinct from

surround tissue.

Hamartoma: Ultrasonogram demonstrates a 3-cm lobulated circumscribed mass that is predominantly hypoechoic (arrows). Some of the fatty tissue within the lesion is hyperechoic (arrowheads), although this is not seen in all hamartomas.

Hamartoma: Ultrasonogram demonstrates a 3-cm lobulated circumscribed mass that is predominantly hypoechoic (arrows). Some of the fatty tissue within the lesion is hyperechoic (arrowheads), although this is not seen in all hamartomas.

This mass is a solitary, slow growing lesion that presents in

the middle aged and postmenapausal female.

The patient is usually asymptotic.

The ultrasound appearance would be similar to normal fatty

lobules found in a normal breast. The lipoma is hypoechoic

in texture. The sound is attenuated and scattered similar to

normal subcutaneous and intrammary fat.

This mass is a solitary, slow growing lesion that presents in

the middle aged and postmenapausal female.

The patient is usually asymptotic.

The ultrasound appearance would be similar to normal fatty

lobules found in a normal breast. The lipoma is hypoechoic

in texture. The sound is attenuated and scattered similar to

normal subcutaneous and intrammary fat.

Lipoma.Lipoma.

A small percentage of patients have lymphoma as a primary

condition, most have metastatic disease secondary to

lymphoma.

It usually is found in the older patient with a right side

predominance. The mass varies from well defined to infiltrative

with poorly defined borders.

On ultrasound the texture is hypo to isoechoic without through

transmission. Axillary nodes are present in 35% of patients. 

A small percentage of patients have lymphoma as a primary

condition, most have metastatic disease secondary to

lymphoma.

It usually is found in the older patient with a right side

predominance. The mass varies from well defined to infiltrative

with poorly defined borders.

On ultrasound the texture is hypo to isoechoic without through

transmission. Axillary nodes are present in 35% of patients. 

LymphomaLymphoma

There is a 1% incidence of metastases to the breast from

primary tumors that include malignant melanoma, ovarian

carcinoma, and leukemia/lymphoma.

The mean age affected is 45 years.

The mass is usually solitary and well circumscribed and

appears in the upper outer quadrant.

One fourth of the patients have skin adherence and 40%

have axillary node involvement.

There is a 1% incidence of metastases to the breast from

primary tumors that include malignant melanoma, ovarian

carcinoma, and leukemia/lymphoma.

The mean age affected is 45 years.

The mass is usually solitary and well circumscribed and

appears in the upper outer quadrant.

One fourth of the patients have skin adherence and 40%

have axillary node involvement.

Metastases To The BreastMetastases To The Breast

ultrasound from a 35 year-old patient with bilateral palpable breast

masses. The ultrasound documented a 19 × 14 mm hypoechoic mass.

She was found to have metastatic disease to her breast from a lung

neuroendocrine carcinoma.

Right breast Left breast 

A sarcoma is a rare malignant mammary lesion occuring in the

middle aged female. The growth is rapid. Borders are well-defined

with lobulations. 

Angiosarcoma is a highly malignant vascular breast tumor that

affects females in the third to fourth decade of life. The mass

gradually enlarges; its borders are ill-defined and there is skin

thickening with nipple retraction. On ultrasound angiosarcoma

presents as a well-defined multilobulated hypoechoic mass with

hyperechoic areas as a result of hemorrhage.

A sarcoma is a rare malignant mammary lesion occuring in the

middle aged female. The growth is rapid. Borders are well-defined

with lobulations. 

Angiosarcoma is a highly malignant vascular breast tumor that

affects females in the third to fourth decade of life. The mass

gradually enlarges; its borders are ill-defined and there is skin

thickening with nipple retraction. On ultrasound angiosarcoma

presents as a well-defined multilobulated hypoechoic mass with

hyperechoic areas as a result of hemorrhage.

Sarcoma and AngiosarcomaSarcoma and Angiosarcoma