Journal reading

HYPERECHOIC LESIONS OF THE

BREAST : RADIOLOGIC-
HISTOPATHOLOGIC CORRELATION
Oleh:
ELLYA RISMAYAN SARI
1110070100190

Preseptor:
dr. Dessy Wimelda, Sp.Rad
 Benign Conditions
1. Hematoma

 Hyperacute  anechoic
 Acute  Hypoechoic
 Subacute  complex cystic + solid
masse with indistinc margins or a thick
hyperechoic wall
 Chronic phases  blood within the hematoma
become increasingly hyperechoic

Circumscribed homogeneously hyperechoic mass

2. Abscess

Hyperechoic mass with marked internal hypervascularity

Hyperechoic  accumulation of WBC’s
3. Fat Necrosis

Right lateromedial mammogram

shows oval isodense mass (arrow)
with indistinc margins at area of
palpable concern (triangle)
 Hyperechoic mass with
indistinc margins (arrow)
and heterogenous internal
hypoechogenicity.

Photomicograph  aggregates of
foamy macropagh (arrows)
admixed with lymphoplasmacytic
infiltrates (arrowhead)
 Benign Neoplasma
1. Hamartoma

Ultrasound oval circumscribed solid masses.

may be hypoechoic, hyperechoic, or have
heterogeneus echogenicity.
 Cranioaudad mammogram show
oval, circumscribed, fat containing
mass (arrow)

Solid oval mixed echogenicity

mass predominantly
hyperechoic
2. Lactating Adenoma
Mammogram  oval masses with radiolucent
areas
Ultrasound  often oval in shape, with circumsribed
margins, and a homegeneous echotexture.
Back to back glandular
proliferation.
3. Angiolipoma

Small mass with indistinc margins.

Progessively enhancing mass (arrow)
Two tumor component admixed:
Vascular component + adipose tissue
4. Myofibroblastoma

Oval mixed density fat

containing mass (arrow)
Oval hyperechoic mass with circumscribed margins (arrow).
Note attenuation of ultrasound bearn related to fat component
(arrowheads)
Spindle cell proliferation admixed with adipocytes.
 5. Hemangioma

Right mediolateral mammogram 

lobular noncalcified mass with
microlobulated margin (arrow)

Superficially located,
solid, oval, hyperechoic
mass
Dilated vessels with bland endothelial lining (arrows)
Focal chronic inflammation is present in stroma
 Malignant Masses
1. Invasive and in situ ductal carcinoma

Oval isodense mass with speculated margins

 Irreguler
predominantly
hyoerechoic mass
with indistinc
margin.

Glandular and nested

tumor cells infiltrating
fibroadipose tissue,
consistent with invasive
ductal cancer.
2. Invasive lobular carcinoma

Architectural distortion (long arrow)

corresponding with palpable abnomality
(triangle) with biopsy clip marker in
posteroinferior margin (short arrow).

Irreguler heterogeneous
predominantly hyperechoic
mass (arrows)
3. Lymphoma

Oval heterogeneous predominantly hyperechoic mass

Oval non calcified mass

(arrow) with indistinc
posterior margins at
site of palpable concern
(triangle)
Intermediate to large sized atypical lymphoid cell
4. Angiosarcoma

Solid heterogeneous primarily hyperechoic mass

with indistinc margin

Irregular noncalcified
mass with indistinc
margin.
Anastomosing vascular channels
(asterisk) that infiltrate into adjacent
lobular structures
5. Liposarcoma

Solid hyperechoic mass with indistinc margins

Tumor is composed of
celullar moderate to
markedly atypical celss
admixed with
multivacyolated lipoblast
 Conclusion
Hyperechoic masses are frequently
benign, including hematoma, fat necrosis,
abscess, and benign neoplasm. Malignant
hyperechoic lesions include invasive ductal
and invasive lobular carcinoma, lymphoma,
and sarcoma. Understanding lesion
echotexture in the context of clinical and
mammographic findings will help establish
appropriate diagnoses for hyperechoic
masses.
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