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Special Feature |

Image of the Month—Quiz Case FREE

Fernando Hernanz, MD; Pilar Alonso-Bartolomé, MD; Francisca Garijo, MD; Alfonso Vega, MD; Estrella Ortega, MD; Angel Alvarez, MD; Manuel Gómez-Fleitas, MD
[+] Author Affiliations

Author Affiliations: Divisions of General Surgery (Drs Hernanz and G[[oacute]]mez-Fleitas), Radiology (Drs Alonso-Bartolom[[eacute]], Vega, and Ortega), Pathology (Dr Garijo), and Gynecology (Dr Alvarez), Hospital Universitario Marqu[[eacute]]s de Valdecilla, Facultad de Medicina, Universidad de Cantabria, Santander, Spain.


Arch Surg. 2007;142(2):201. doi:10.1001/archsurg.142.2.201.
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Published online

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, rubbery-firm, 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 increased density at the inferior quadrants without calcifications (Figure 1). Core-needle 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. Contrast-enhanced, 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.

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Figure 1.

Mammogram shows a dense mass without calcifications.

Graphic Jump Location

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Figure 2.

Gadolinium contrast-enhanced image revealed an intense ring-enhancing mass with large arteries and veins going to the mass.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Phyllodes tumor

B. Angiosarcoma

C. Hamartoma

D. Fibroadenoma

Figures

Place holder to copy figure label and caption
Figure 1.

Mammogram shows a dense mass without calcifications.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Gadolinium contrast-enhanced image revealed an intense ring-enhancing mass with large arteries and veins going to the mass.

Graphic Jump Location

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