Lobular breast carcinoma is a subtype of breast cancer can range from lobular carcinoma in situ (LCIS) to invasive lobular carcinoma.
Multicentricity and bilaterality tend to be quite common with lobular breast carcinomas.
Lobular carcinoma in situ (LCIS) represents the next step up from atypical lobular hyperplasia (ALH) along the malignant spectrum of lobular breast carcinoma.
LCIS occurs predominantly in premenopausal women with a mean age of 45 years old, approximately 10-15 years younger than t...
Lymphatic drainage of breast originates from breast lobules and flows through intramammary nodes and channels into a subareolar plexus, called Sappey’s plexus. From this plexus, lymphatic drainage takes place through three main routes that parallel venous tributaries. Lymphatics from the left br...
Lymphocytic mastitis, also known as lymphocytic mastopathy or sclerosing lymphocytic lobulitis, is a rare benign inflammatory disease of the breast that can mimic breast cancer.
Diabetic mastopathy is a closely-related entity although it is sometimes used synonymously in the litera...
Lymphoscintigraphy is a nuclear medicine technique to visualize regional lymphatic drainage, especially for mapping sentinel lymph nodes, from a site of radiopharmaceutical injection.
Colloidal agents are used as these particles enter lymphatic channels and migrate to lymph...
A magnification view in mammography is performed to evaluate and count microcalcifications and its extension (as well the assessment of the borders and the tissue structures of a suspicious area or a mass) by using a magnification device which brings the breast away from the film plate and close...
Male breast cancer is exceptionally rare and only accounts for less than 0.25% of male malignancies and ~0.5-1% of all breast cancer (both genders). The diagnosis is sometimes delayed due to the patient's hesitancy to seek advice. Workup from a radiological point of view is the same as for women...
Male breast disease includes a wide spectrum of conditions. Many conditions and entities that affect the female breast may also affect the male breast.
male breast cancer
pseudogynecomastia: fat deposition within the b...
Malignant phyllodes tumor of the breast accounts for up to a quarter of the phyllodes tumors.
Please, refer to the main article on phyllodes tumors for a general discussion.
It is generally thought that it is the stromal component that becomes malignant 4. This may account for thei...
Mammary duct ectasia is the abnormal widening of one or more breast ducts to greater than 2 mm diameter, or 3 mm at the ampulla. It can be due to benign or malignant processes.
Some publications use this term synonymously with periductal mastitis 7 or plasma cell mastitis 10,11, wh...
The mammary glands
develop in close association with a depot of adipose tissue that is commonly
referred to as the mammary fat pad.
The mammary fat pad is a matrix of adipose
and connective tissue capable of mediating hormone action and synthesizing an
array of growth regulatory molecules.
Mammary myofibroblastoma is a rare, benign, circumscribed mesenchymal breast tumor.
It is the only breast tumor that occurs more commonly in males than females 2. It also has a tendency to occur more often in elderly males and postmenopausal women.
It arises from the ...
Mammography is a dedicated radiographic technique for imaging the breast.
Types of mammography
In general terms, there are two types of mammography: screening and diagnostic.
Mammography differs significantly in many respects from the rest of diagnostic imaging.
There are numerous mammography views that can broadly be split into two groups
supplementary views - additional information or problem solving
Standard views are bilateral craniocaudal (CC) and mediolateral oblique (MLO) views, which comprise routine screening ...
MammotomeTM is the brand name for the first vacuum-assisted breast biopsy system. See the article on stereotactic breast biopsy for general discussion of the procedure.
Mastitis refers to inflammation of the breast parenchyma, of which there are a number of subtypes:
puerperal mastitis: occurs usually from infection with Staphylococcus during lactation
non-puerperal mastitis: not related to lactation, and occurs usually in older women
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
tubing, clamps, syringes lying on or under the patient
rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc. may also be visible
The mediolateral oblique (MLO) view is one of the two standard mammographic views, alongside the craniocaudal (CC) view.
It is the most important projection as it allows to depict most breast tissue.
The representation of the pectoral muscle on the MLO view is a key component in as...
The mediolateral (ML) view is a supplementary mammographic view and shows less breast tissue and pectoral muscle than the mediolateral oblique view (MLO view).
The tube is rotated 90 degrees and the lateral aspect of the chest wall is along the bucky edge. The height is at the level ...
Medullary carcinoma of the breast (MCB) is an uncommon subtype of breast cancer and accounts for ~5% 1,4 of all breast cancers.
They tend to occur more frequently in younger women than other breast cancer types 7. The mean age of presentation varies from 46-54 years but in 10% of ...
Metachronous breast cancers are two breast cancers that occur in either breast in two different time periods.
Treatment and prognosis
The survival rate of women with metachronous breast cancers diagnosed within 2 years of the original primary is worse than those with unilateral disease 4.
Metaplasia is a general pathology term that refers to process when one cell type is replaced by another. It usually occurs in the context of a changed cellular environment to which the new cell type is better adapted 1. Examples include 2-5:
Barrett esophagus: normal squamous epithelium replace...
Metaplastic breast carcinoma (MBC), also known as spindle cell carcinoma of the breast (SpCC), is a rare form of primary breast malignancy and accounts < 5% of breast carcinomas.
These are scarce lesions, rarely seen in general radiology practice. The lesions usually present as a mass in postme...
Metastases to the breast from non-mammary primary tumors are uncommon and account for 0.5-2.0% of all breast malignancies.
Metastases do not tend to cause retraction of the skin or nipple. Metastatic lesions are much more likely to be multiple or bilateral than primary c...
Metastatic axillary lymphadenopathy of unknown primary can be a very chellanging situation.
Usual potential sites include:
occult breast cancer: the incidence of an axillary lymph node manifestation from an occult primary breast cancer is low, ranging from 0.3-0.8% of all patients ...
A metastatic intramammary lymph node refers to an intramammary lymph node involved with metastatic or malignant disease.
Sonographic features that suggest metastatic involvement include 4:
disappearance or loss of central echogenic hilar region
Microglandular adenosis (MGA) of the breast is a pathological subtype of mammary adenosis. It is benign breast condition although can mimic a breast cancer (particularly tubular breast carcinoma 3,5) both clinically, radiology and pathologically.
It is considered the only benign brea...
Microinvasive carcinoma is a type of epithelial breast cancer in which microscopic foci of tumor cells infiltrate the breast stroma.
Microinvasive carcinoma is defined histologically as one or more clearly separate foci of tumor cells ≤1 mm in size infiltrating the mammary stroma 1. ...
A milk fistula is a situation where a fistulous connection develops between there skin and the lactiferous ducts. It is rare but potential complication if a core biopsy or excision biopsy of the breast is performed in a lactating patient.
The term milk of calcium (MOC) is given to dependent, sedimented calcification within a cystic structure or hollow organ. This sort of colloidal calcium suspension layering can occur in various regions:
renal: milk of calcium in renal cyst (most common)
breast: milk of calcium in breast cyst
Milk of calcium within a breast cyst is a mammographic feature observed when there is dependent calcium layering within breast cysts. It is typically observed as "tea cup" or "crescent shaped" calcifications on a true lateral (LM or ML) view on occasionally on a MLO view. On a CC view, these cal...
Mondor disease is a rare benign breast condition characterized by thrombophlebitis of the subcutaneous veins of the breast and anterior chest wall.
Although Mondor disease is rarely reported in the literature, this is likely in part due to lack of awareness of the entity. It tends...
Montgomery glands are large sebaceous glands in the breast, representing a transition between a mammary gland and a sweat gland.
Located within the nipple-areolar complex, Montgomery glands open onto the skin surface via protrusions on the skin known as Montgomery tubercles. They...
Montgomery tubercles are the openings of Montgomery glands on the skin surface.
They are about 1-2 mm papules on the skin surface located on the skin of the nipple and areola.
These tubercles become prominent during stimulation and pregnancy
They are named after Wi...
Mucinous carcinoma of the breast, also known as colloid breast carcinoma, is a subtype of invasive ductal carcinoma (IDC). They account for about ~ 2% (range 1-7% 4) of breast cancers.
It tends to occur in older women where a prevalence of as much as 7% is found among women 75 ye...
A multicentric breast cancer is a term given to a breast cancer where there are two or more breast cancers separated by normal breast tissue (often taken as 5 cm of separation 4). It is related to but distinct from the term multifocal breast cancer.
At a pathological level It can also mean 2
Multifocal breast cancer refers to two or more individual breast cancers diagnosed at the same time within the same quadrant of the same breast 1.
Neonatal mastitis is rare and refers to infection of the breast tissue occurring in a neonate.
Patients may present with unilateral breast erythema and pain sometimes with associated nipple discharge and lymphadenopathy. It usually occurs in patients under five weeks of a...
Breast manifestations of neurofibromatosis type 1 (NF1), or von Recklinghausen disease, it is characterized by multiple subcutaneous neurofibromas affecting the breast.
For a general discussion of the underlying condition, please refer to the article on neurofibromatosis type 1.
Nevoid hyperkeratosis of the nipple and the areola (NHNA) is a rare, idiopathic and benign dermatological condition.
Most often seen in females of reproductive age, especially during 2nd and 3rd decades of life. Less than 70 cases have been reported till now.
Nipple adenoma is a rare, benign breast lesion which often mimics a malignancy
Patient presents with bloody discharge from an ulcerated and painful nipple in one breast. There is itching associated with this lesion. Symptoms may show variation with the menstrual cycle. T...
During the 6th week of gestation, a pair of longitudinal thickening of the epidermis develop on the ventral surface of the embryo, extending from the axilla to the medial thigh, called "mammary ridges" (or "mammary line", “milk lines"). In large part these milk lines later atrophy, leaving only...
Nipple inversion is an important finding on mammography and correlation with patient history is essential. When nipple abnormalities such as inversion are identified, it is important for the technologist to document them in the medical record / mammography worksheet so that the radiologist will ...
Nipple markers can be a useful technique in the evaluation of small radiodensities overlying the expected position of the nipple on a chest radiograph. Not uncommonly a small round opacity projects over the lower thorax on a chest radiograph (see: solitary pulmonary nodule).
Often, especially i...
Non-comedo type ductal carcinoma in situ is a subgroup of ductal carcinoma in situ (DCIS). This group comprises of relatively less aggressive types with low nuclear grade. It has multiple patterns which are often mixed:
cribriform type non-comedo DCIS
micropapillary type non-comedo DCIS
Nonmass enhancement at breast MRI is defined in the BI-RADS lexicon as an area of enhancement that does not meet criteria for a mass, such as by having nonconvex borders or intervening fat or fibroglandular tissue between the enhancing components.
A wide variety of benign, ...
A non-mass finding on breast ultrasound refers to a discrete region of altered breast parenchymal echotexture that does make a mass shape (i.e. non-identifiable in two planes). "Non-mass finding" is not a current BI-RADS descriptor.
Non-mass findings are described in numerous ways...
With increasing use of screening mammography and ultrasound for various indications, a large number of non-palpable breast lesions are being detected.
Among this large number of non-palpable masses, not all are malignant. The incidence of malignancy among these non-palpable lesions varies betwe...
This article lists examples of normal imaging of the breast and surrounding structures, divided by region and modality.
MLO and CC (standard mammographic views)
lateral: example needed
compression: example needed
cleavage view: exampl...
The Nottingham classification is used at the end of work up of a breast lesion to help guide management.
A = malignant
lesion needs surgical excision regardless of biopsy result
B = indeterminate
will accept a benign biopsy result, but only if it is congruent with imaging, i.e. a well circum...
Oil cysts in breast imaging refer to benign breast lesions where an area of focal fat necrosis becomes walled off by fibrous tissue.
Occurs across all age and ethnic groups with a female predilection. Usually associated with blunt trauma, if present in males.
Paget disease of the breast, which is also known as Paget disease of the nipple, has traditionally been described as a form of breast malignancy characterized by infiltration of the nipple epidermis by malignant cells. Although most cases have underlying focus or foci of in situ or invasive carc...
Paget disease can refer to:
Paget disease of bone
Paget disease of breast
extramammary Paget disease
History and etymology
These conditions are named after Sir James Paget (1814-1899) 1,2, British surgeon and pathologist.
Papillary carcinoma of the breast is a rare ductal breast malignancy.
They are thought to account for 1-2% of breast carcinomas 2. They typically present in postmenopausal patients with the mean age at being ~63-67 years.
A papillary carcinoma may manifest ...
Papillary lesions of the breast comprise a wide group and range from benign to malignant.
They develop as tufts of epithelium with a ﬁbrovascular core that arborize into branching papillae and protrude into the duct lumen.
papilloma of breast / intraductal papilloma of the b...
Parenchymal patterns in breast imaging influence mammographic screening sensitivity and is related to the risk of breast cancer. This article describes the historical classifications of breast density. See the main article on breast density for the currently accepted BI-RADS descriptors.
The pectoralis major muscle is a large fan-shaped muscle of the pectoral region, overlying the anterior chest wall but often considered an upper limb muscle due to its function.
origin: medial clavicle, sternum, costal cartilages, and external oblique aponeurosis
Perforating branches of the internal thoracic arteries arise from the paired internal thoracic arteries (also known as internal mammary arteries) and run in the superior six intercostal spaces. These arteries pierce the internal intercostal muscles and pectoralis major, contributing to the blood...
PGMI (Perfect, Good, Moderate, Inadequate) is a method of evaluation of clinical image quality in mammography developed by the United Kingdom Mammography Trainers Group with the support of the Royal College of Radiographers, aimed to ensure the maintenance of a high standard of mammography in Br...
Phyllodes tumor, also known as cystosarcoma phyllodes, is a rare fibroepithelial tumor of the breast which has some resemblance to a fibroadenoma. It is typically a large, fast growing mass that forms from the periductal stroma of the breast.
Phyllodes tumors account for less than...
Plasma cell mastitis is a benign breast condition which represents calcification of inspissated secretions in or immediately adjacent to ectatic benign ducts.
It is typically seen in older women (e.g. >60 years of age).
It is thought to represent aseptic inflammation ...
Poland syndrome refers to a congenital unilateral absence of the pectoralis major and minor muscles and is a recognized cause of unilateral hyperlucent hemithorax.
Poland syndrome is usually sporadic, although rare familial cases have been described 1. It is rare, with an estimat...
Popcorn calcification refers to amorphous calcifications often with rings and arcs that resemble popped corn kernels. This type of calcification may be seen in many radiological settings including 1:
chondroid lesions (e.g. enchondroma, chondrosarcoma)
Popcorn calcification in the breast is the classical description for the calcification seen in involuting fibroadenomas which, as the name suggests, has a popcorn-like appearance.
A fibroadenoma in the long run may degenerate and calcify. Initially there are a few punctate periphera...
The posterior nipple line (PNL) refers to a line drawn posteriorly and perpendicularly from the nipple towards the pectoral muscle (or the posterior image edge in CC) on the mammograms. In an adequately positioned breast, the measurement difference of this line between a CC view and MLO view sho...
Post surgical breast scar is a benign complication that usually occurs following surgical intervention to breast tissue. It can however be a strong and potentially very confusing mimicker of breast malignancy.
Review of the patient's past history and previous mammography...
Pregnancy associated breast cancer (PABC) is usually defined as a breast cancer diagnosed during pregnancy or one year following delivery. PABC occurs in one out of every 1500-10,000 pregnancies 5-6 and represents up to 3% of all breast malignancies. The incidence may be increasing due to many w...
Premature thelarche refers to onset of female breast development before age 7–8 years. As with age-appropriate thelarche, premature thelarche may be asymmetric or unilateral.
Premature thelarche may occur as an isolated event or as part of precocious puberty. Isolated premature thelarche gener...
Primary breast chondrosarcoma is a rare type of sarcoma that originates from the mammary stroma and not from the underlying bone or cartilage of the chest wall.
The prevalence of primary breast chondrosarcoma is reported to be 0.5-1%, they represent <5% of all sarcomas 1,14.
Primary osteosarcoma of the breast is an uncommon breast malignancy and is a sub type extraskeletal osteosarcoma.
While it can present in a wide are group, the peak age at presentation is around the 6th decade 7.
The presence of bone in breast lesions is not diagnosti...
Prostate specific antigen (PSA) is currently used as a tumor marker for prostate adenocarcinoma.
PSA is a 33 kilodalton glycoprotein produced in prostate epithelial cells. Its normal physiologic role is as a liquefying agent for seminal fluid; only a tiny amount leaks into the blood, therefore ...
Pseudoangiomatous stromal hyperplasia (PASH) is a benign, relatively uncommon form of stromal (mesenchymal) overgrowth within breast tissue that derives from a possible hormonal etiology.
Typically affects women of reproductive age. It rarely affects males.
Pseudocalcifications and artifacts in the breast include
gold deposits in lymph nodes from intramuscular gold therapy for rheumatoid arthritis
They should be differentiated from parenchymal calcification. Precautions to be taken are t...
Pseudogynecomastia refers to breast enlargement in men primarily due to fatty tissue but with no associated glandular or stromal tissue.
Puerperal mastitis refers to mastitis occurring during pregnancy and lactation.
It occurs most often during breast feeding and is rarely encountered during pregnancy.
The source of infection is the nursing infants nose and throat; the organisms being Staphylococcus aur...
Punctate microcalcifications in the breast are defined as calcific opacities <0.5 mm in diameter seen within the acini of a terminal duct lobular unit.
rarely in DCIS: punctate, clustered, segmentally distributed
Radial scar, or complex sclerosing lesion, is a rosette-like proliferative breast lesion. It is not related to surgical scarring. Some authors, however, reserve the latter term to lesions over 1 cm 5.
It is an idiopathic process with sclerosing ductal hyperplasia.
Its significance is that it...
Radiation-induced breast cancers are a potential long-term complication of radiotherapy to the chest, in particular, in those patients receiving irradiation for breast cancer or Hodgkin lymphoma.
Besides breast cancer, sarcomas (breast angiosarcoma or osteosarcomas arising from the irradiated ...
Radiation-induced breast changes are a consequence of radiotherapy toxicity over the breast tissues either related to targeted breast cancer treatment or other thoracic malignancies (eg. lung cancer).
The radiation-induced breast changes may be seen in either dedicated b...
The RCR Breast Group (RCRBG), a working group formed by the Royal College of Radiologists (RCR) in the United Kingdom, published their standardized classification for breast imaging findings in 2009 1. The fourth edition was published in November 2019 2. This 5-point scale is used to classify t...
The term recurrent breast cancer in medical imaging is given to recurrence of malignancy within the same breast at or close to the resection bed more than two years following surgical excision.
The rate of local recurrence may be as high as 19% in 10 years. The maximum for recurre...
A residual breast cancer is a remaining portion of the original primary breast cancer after an incomplete resection or following radiotherapy or chemotherapy. The term is particularly used in assessing patients who have had neo-adjuvant chemo +/- radiotherapy.
The reversed CC view is an additional view. It is useful for the study of breasts with surgical scars in the lower quadrants. The ability to see the scar through the compressor paddle offers to the mammographer the possibility to flatten it properly, reducing the formation of scar folds as well ...
Given that the rolled projections can be performed from any standard projection, the most commonly used is certainly the cranio-caudal one.
A rolled CC view It's performed to locate a lesion only visible in the cranio-caudal view, or when overlapped tissues in the standard view can simulate or...
Rotter lymph nodes (also known as interpectoral nodes) are lymph nodes located in the interpectoral fascia in Rotter space, between the pectoralis major and pectoralis minor muscles. Their number varies from one to four. They are usually considered to be a separate nodal group from the level I a...
Round breast calcifications are a mammographic descriptor of typically benign breast calcifications characterized by a round shape. In the 5th edition BI-RADS lexicon, the morphologic descriptor encompasses punctate calcifications, but the latter term more specifically applies to such calcificat...
Salad oil sign, also referred to as the droplet sign, is characterized by small rounded high T2 signal foci within a breast implant on MRI studies and represents water droplets or small amounts of gas within the silicone. It also can be characterized as hypointense foci on the water-suppressed s...
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Sappey plexus is a network of lymphatics in the areola of the nipple. Sappey plexus assumes considerable importance in the identification of the sentinel lymph node since the subareolar route is the most straightforward to infiltrate with an injected radiotracer/dye and the most suitable in spec...
Scirrhous carcinoma of the breast is a pathological subtype of breast cancer. It is a subtype of invasive ductal carcinoma not otherwise specified and presents as a hard lump. The proportion of pathologic lymph node metastasis among scirrhous carcinomas is significantly higher than that among ca...
Sclerosing adenosis (SA) is a benign proliferative condition of the terminal duct lobular units characterized by an increased number of acini and their glands. It manifests as multiple small, firm, tender nodules, fibrous tissue, and variable microcysts within the breast. It is sometimes placed ...
Sclerosing lobular hyperplasia (SLH) of the breast, also known as fibro-adenomatoid mastopathy, is an uncommon benign proliferative breast lesion.
It tends to occur more often in adolescent and young adult patients (peak age in the thirties). In the United States, there may be a g...
Sclerosing papillomas of the breast are a sub type of intraductal papilloma of breast. It is termed when a papillary lesion form well-defined solid masses with a dominant sclerosed architecture 2. It is usually a histological diagnosis and usually cannot be differentiated from a non sclerosing p...