Foreign body granulomas of the breast presenting as bilateral spiculated masses

Breast paraffinoma: An obsolete but still important condition - Experience with 60 cases and the literature review

BACKGROUND

Paraffin injections for breast augmentation has been abandoned by clinicians because of its serious long-term complications. The practice is still prevalent and long-term complications are still being encountered in clinical practice today.

METHODS

Retrospective review was performed on patients with breast paraffinoma managed in Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam, between January 1, 2010 and August 31, 2020. Patients' demographics, presentations, investigations, treatment and follow-up outcomes were reviewed. A literature review on breast paraffinoma was also performed.

RESULTS

We reviewed the data by combining our dataset of 60 patients with those extracted from the published articles, totaling 232 patients from 31 articles. The mean age at presentation was 48.8 (range 29-78) years with a preponderance of female patients. The most common presenting symptoms were painless lumps (65.5%), painful lumps (14.7%), ulcer (7.3%), skin discoloration (2.4%), sinus (1.7%) and abscess (1.0%). The most common imaging modality used was mammography (70.7%), MRI (52.6%) and ultrasonography (47.8%). Majority of the reported cases underwent surgical treatment; mastectomy was performed in 53.4% of the cases, excision of the paraffinoma in 17.7% of cases and 0.9% of cases had incision and drainage. A quarter of the patients (25%) did not require any further treatment. The mean follow-up was 4 (range 1-10) years with a mortality rate of 3.0%.

CONCLUSIONS

Awareness of this condition will assist the clinicians in making the correct diagnosis and instituting the appropriate treatment. It is important to exclude co-existing breast cancer.

MRI Features of Free Liquid Silicone in the Transgender Female Breast

OBJECTIVE

To define MRI features of free liquid silicone injection (FLSI) of the breast in transgender women considering surgical management.

METHODS

This study was IRB-approved. MRI images from transgender women with FLSI imaged between 2009 and 2019 were reviewed. Presence and location of fibrotic masses (FMs) in the breast(s) and pectoralis muscle and patterns of granulomas were correlated with clinicopathologic findings. Background enhancement was quantified. Comparisons were performed using two-tailed Fisher exact and Student's t test.

RESULTS

Of 21 transgender women with FLSI (mean age 46.8 years), 13/21 (61.9%) had a dominant FM measuring over 4 cm; these were limited to breast and pectoralis in 6/21 (28.6%), breast in 9/21 (42.9%), and pectoralis only in 2/21 (9.5%). Four of 21 patients (19.0%) had no FMs, and 4/21 (19.0%) had masses under 4 cm. Mean size of the dominant FM was 7.4 cm (range 4-12 cm). FMs were enhancing in 5/13 (38.5%) and contained T2 high signal granulomas in 8/13 (61.5%). While 18/21 (85.8%) of cases showed mild to moderate overall background enhancement, the majority 7/13 (61.5%) of dominant FM were non-enhancing. About half of cases (11/21, 52.4%) had diffuse foci, and half (10/21, 47.6%) had diffuse foci and masses throughout the breast and pectoralis muscle. These foci and masses displayed T2 high signal in 13/21 (61.9%). There were no occult carcinomas observed.

CONCLUSION

MRI performed on symptomatic FLSI patients considering surgical treatment is helpful in assessing the extent of silicone infiltration and fibrotic reaction of the breast and pectoralis muscle.

Cholesteroloma of the breast: A 10 year retrospective review of 79 cases with radiology correlation

A cholesteroloma or cholesterol granuloma of the breast is an uncommon lesion representing an inflammatory/reactive process with unclear etiology. In this study, we reviewed our 10-year experience with cholesteroloma of the breast with clinical, radiologic, and histopathological correlation. Seventy-nine cases were selected. The mean patient age was 57.7 (range 25-90) years old. Patients had hypercholesterolemia with mean blood cholesterol level of 201 mg/dL (P < 0.001). The mean body mass index (BMI) was 26.7 kg/m² (P = 0.1976). The indications for the breast biopsies were mass lesion on radiology (85.5%, n = 65) and microcalcifications (10.5%, n = 8). Of the 65 cases of the mass lesions, 52 presented as solid masses and 13 were cystic. On the diagnostic mammogram or ultrasound, 81.9% were BI-RADS 4% and 6.9% were BI-RADS 5. Macrocysts were the most common pathological finding associated with cholesteroloma suggesting the etiology of cholesteroloma may be the result of repair process from obstruction and rupture of the macrocysts. Six cases (9.2%) of cholesterolomas had persistent masses during follow-up. The recognition of this lesion and radio-pathological correlation can help us better understand this entity and distinguish it from its mimickers.

Breast Imaging of Transgender Individuals: A Review

PURPOSE

This review will inform radiologists about the evidence base regarding radiographic imaging for transgender individuals and considerations for providing culturally sensitive care for this population.

FINDINGS

Transgender individuals are increasingly referred for both screening and diagnostic breast imaging. It is important that the clinic environment is welcoming, the medical staff utilize accepted terminology and patients are able to designate their gender and personal history to ensure appropriate care. Hormone and surgical treatments used for transition by many transgender women and men may change the approach to imaging.

SUMMARY

Although not yet evidence-based, screening mammography is currently suggested for transgender women with risk factors, including those receiving hormone treatment over 5 years. The risk for breast cancer in transgender individuals is still being defined.

Are Irregular Hypoechoic Breast Masses on Ultrasound Always Malignancies?: A Pictorial Essay

Irregular hypoechoic masses in the breast do not always indicate malignancies. Many benign breast diseases present with irregular hypoechoic masses that can mimic carcinoma on ultrasonography. Some of these diseases such as inflammation and trauma-related breast lesions could be suspected from a patient's symptoms and personal history. Careful ultrasonographic examination and biopsy could help to differentiate these from malignancies.

A rare cause of breast mass that mimics carcinoma: Foreign body reaction to amorphous surgical material

A breast mass caused by foreign body type granulomatous reaction to surgical material is a very rare lesion and may mimic carcinoma. Reported foreign materials have included suture materials, silicone, paraffin, gunpowder and carbon particles used for localization of a nonpalpable breast lesions. To our knowledge, a foreign body reaction to gauze sponge has not been reported previously. A 58-year-old woman who had an enlarging mass that mimicked breast carcinoma, due to foreign body reaction to gauze sponge is presented here, and relevant literature is reviewed.