Breast metastases from extramammary malignancies are uncommon. The most common sources are lymphomas/leukemias and melanomas. Some of the less common sources include carcinomas of the lung, ovary, and stomach, and infrequently, carcinoid tumors, hypernephromas, carcinomas of the liver, tonsil, pleura, pancreas, cervix, perineum, endometrium and bladder. Breast metastases from extramammary malignancies have both hematogenous and lymphatic routes. According to their routes, there are common radiological features of metastatic diseases of the breast, but the features are not specific for metastases. Typical ultrasound (US) features of hematogenous metastases include single or multiple, round to oval shaped, well-circumscribed hypoechoic masses without spiculations, calcifications, or architectural distortion; these masses are commonly located superficially in subcutaneous tissue or immediately adjacent to the breast parenchyma that is relatively rich in blood supply. Typical US features of lymphatic breast metastases include diffusely and heterogeneously increased echogenicities in subcutaneous fat and glandular tissue and a thick trabecular pattern with secondary skin thickening, lymphedema, and lymph node enlargement. However, lesions show variable US features in some cases, and differentiation of these lesions from primary breast cancer or from benign lesions is difficult. In this review, we demonstrate various US appearances of breast metastases from extramammary malignancies as typical and atypical features, based on the results of US and other imaging studies performed at our institution. Awareness of the typical and atypical imaging features of these lesions may be helpful to diagnose metastatic lesions of the breast.
Adenocarcinoma/secondary/ultrasonography ; Adolescent ; Adult ; Breast Neoplasms/*secondary/*ultrasonography ; Breast Neoplasms, Male/secondary/ultrasonography ; Carcinoma/secondary/ultrasonography ; Female ; Humans ; Lymphatic Metastasis/ultrasonography ; Lymphoma, Extranodal NK-T-Cell/pathology/ultrasonography ; Lymphoma, Large B-Cell, Diffuse/pathology/ultrasonography ; Male ; Melanoma/secondary ; Middle Aged ; Multiple Myeloma/secondary/ultrasonography ; Neoplastic Cells, Circulating/pathology

OBJECTIVE: To compare sonography and mammography in terms of their diagnostic value in breast cancer cases which initially presented as an axillary mass without a palpable mass or other clinical symptoms. MATERIALS AND METHODS: Seven patients with enlarged axillary lymph nodes who first presented with no evidence of palpable breast lesions and who underwent both mammography and sonography were enrolled in this study. In six of the seven, the presence of metastatic adenocarcinoma was confirmed preoperatively by axillary needle aspiration biopsy; in four, subsequent sonographicallyguided breast core biopsy performed after careful examination of the primary site indicated that primary breast cancer was present. In each case, the radiologic findings were evaluated by both breast sonography and mammography. RESULTS: Breast lesions were detected mammographically in four of seven cases (57%); in three of the four, the lesion presented as a mass, and in one as microcalcification. In three of these four detected cases, fatty or scattered fibroglandular breast parenchyma was present; in one, the parenchyma was dense. In the three cases in which lesions were not detected, mammography revealed the presence of heterogeneously dense parenchyma. Breast sonography showed that lesions were present in six of seven cases (86%); in the remaining patient, malignant microcalcification was detected at mammography. Final pathologic examination indicated that all breast lesions except one, which was a ductal carcinoma in situ, with microinvasion, were infiltrating ductal carcinomas whose size ranged from microscopic to greater than 3 cm. At the time of this study, all seven patients were alive and well, having been disease free for up to 61 months after surgery. CONCLUSION: In women with a palpable axillary mass confirmed as metastatic adenocarcinoma, breast sonography may be a valuable adjunct to mammography.
Adenocarcinoma/radiography/secondary/*ultrasonography ; Adult ; Axilla/*pathology ; Biopsy, Needle ; Breast/*pathology ; Breast Neoplasms/pathology/radiography/*ultrasonography ; Carcinoma, Infiltrating Duct/pathology/radiography/*ultrasonography ; Carcinoma, Intraductal, Noninfiltrating/pathology/radiography/*ultrasonography ; Female ; Human ; Lymph Nodes/radiography/*ultrasonography ; Mammography ; Middle Age ; Ultrasonography, Mammary

Two Korean women (41 and 23-years of age) presented with painful breast enlargement and redness. The involved breast was confirmed as metastatic signet ring cell carcinoma. Although metastatic signet ring cell carcinoma of the breast shows similar clinical symptoms to inflammatory breast cancer, the difference between the two is that this malignancy showed no microcalcifications or mass on radiographic findings (mammograms and US). Therefore, after the confirmation of signet ring cell carcinoma of the breast has been made, metastatic signet ring cell carcinoma should be considered if there are no microcalcifications or masses evident on radiographic findings.
Adult ; Breast Neoplasms/secondary* ; Breast Neoplasms/radiography* ; Breast Neoplasms/pathology ; Carcinoma, Signet Ring Cell/secondary* ; Carcinoma, Signet Ring Cell/radiography* ; Carcinoma, Signet Ring Cell/radiography* ; Case Report ; Female ; Human ; Stomach Neoplasms/pathology* ; Tomography, X-Ray Computed ; Ultrasonography

Breast metastasis from nonmammary malignant neoplasms is uncommon, and it accounts for approximately 2% of all breast tumors. Distant metastasis of thymoma is very rare, and especially to extrathorcic areas. We report a female who had a metastatic thymoma in her breast 20 years after undergoing resection for a non-invasive thymoma. She presented with a palpable mass in her left breast. Mammography and ultrasonogram showed a lobular mass at the anterior glandular portion. Histological examination after surgical excision revealed a metastatic thymoma.
Breast Neoplasms/diagnosis/*secondary/surgery ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Thymoma/diagnosis/*secondary/surgery ; Thymus Neoplasms/diagnosis/*pathology/surgery ; Tomography, X-Ray Computed ; Ultrasonography, Mammary

The purpose of this study was to evaluate imaging findings of metastatic disease to the breast. We analyzed 15 cases that had been previously examined by radiographic study (comprising a total of 11 mammograms, 13 ultrasounds and 3 chest CT). Primary malignancies included the following: 6 breast cancers, 5 stomach cancers, 2 melanomas, 1 cervical cancer, and 1 lung cancer. Radiologic findings were analyzed and the 15 cases were divided into two groups: hematogeneous and lymphangitic metastasis. Eleven cases were classified as lymphangitic metastasis (73.3%) and 4 cases were hematogeneous metastasis (26.7%). Multiple masses were shown in 13 cases (86.7%), and 12 cases displayed unilateral lesions (80%). There was no evidence of calcification. In the 11 cases with available mammogram, 7 cases (63.6%) revealed multiple masses with well-defined (2 cases, 28.6%) or ill-defined margin (5 cases, 71.4%) and 6 cases (54.5%) showed diffuse increased density and skin thickening. Among the 11 cases that revealed mass lesions on ultrasound, 2 cases showed a well-defined margin (18.2%) and 9 cases showed an ill-defined margin (81.8%). Posterior shadowing of the mass was seen in only 1 case. Four cases (36.3%) showed a minimal echogenic boundary around the mass. Eight cases showed diffuse skin thickening (53.3%). Three cases with chest CT showed multiple masses and/or diffuse skin and trabecular thickening of the breast. In conclusion, the characteristic imaging findings of metastatic disease to the breast are multiple ill-defined masses with a lack of desmoplastic reaction and no calcification, as compared to primary breast carcinoma. The diffuse lesions without evidence of breast mass on mammogram and US could be distinguishable from inflammatory carcinoma of breast origin.
Adult ; Breast Neoplasms/*diagnosis/*secondary ; Female ; Human ; Mammography ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.
Adenocarcinoma/drug therapy/*secondary ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biopsy, Needle ; Bone Neoplasms/secondary ; Breast Neoplasms/drug therapy/*secondary ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms/*pathology ; Lymphatic Metastasis ; Mammography ; Middle Aged ; Neoplasm Staging ; Tomography, X-Ray Computed ; Ultrasonography, Mammary

The purpose of this paper is to show the clinical and radiologic features of a variety of diffuse, infiltrative breast lesions, as well to review the relevant literature. Radiologists must be familiar with the various conditions that can diffusely involve the breast, including normal physiologic changes, benign disease and malignant neoplasm.
Adult ; Aged ; Aged, 80 and over ; Breast Diseases/*diagnosis/pathology ; Breast Neoplasms/diagnosis/pathology/secondary ; Female ; Humans ; Magnetic Resonance Imaging ; Mammography ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography, Mammary

Breast metastases in cases leukemia are very rare and occur primarily in patients with acute myeloid leukemia. We report the involvement of breast metastases in a 30-year-old woman with acute T cell lymphoblastic leukemia. The patient's mammograms revealed an extremely dense pattern with ill-defined, denser mass-like lesions in both breasts. A bilateral breast ultrasonographic evaluation revealed lobular-shaped and partly ill-defined hypoechoic masses with a multi-septated nodular (mottled) appearance.
Adult ; Breast Neoplasms/drug therapy/radiography/*secondary/ultrasonography ; Diagnosis, Differential ; Female ; Humans ; Mammography ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/*pathology ; Ultrasonography, Mammary

OBJECTIVETo investigate the efficacy, indication and complication of radiofrequency ablation (RFA) with cool-tip needle in patients with hepatic malignancies.

METHODS421 patients with hepatic malignancies underwent ultrasound-guided RFA with cool-tip needle under local anaesthesia. The tumor size was from 1.0 to 15 cm in diameter with an average diameter of 4.3 cm.

RESULTSThe complete ablation (CA) rate was 91.4% (382/418) in the patients with a tumor < 3 cm, 78.9% (97/123) in those with a tumor of 3 to 5 cm and 37.6% (35/93) in the patients with a tumor > 5 cm. No patient died or changed to celiotomy during the 1121 times of RFA for 634 lesions in 421 patients. No hemorrhage occurred in any of these patients after the RFA treatment. The complications included abdominal pain in 32.3% (136/421), nausea in 9.0% (38/421), fever in 34.9% (147/421) and biliary leakage in 0.2% (1/421) of the patients.

CONCLUSIONUltrasound-guided percutaneous radiofrequency ablation with cool-tip needle is effective and safe in the treatment of liver tumors.

Abdominal Pain ; etiology ; Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; secondary ; Catheter Ablation ; adverse effects ; methods ; Female ; Fever ; etiology ; Gastrointestinal Neoplasms ; secondary ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Nausea ; etiology ; Ultrasonography, Interventional

OBJECTIVETo analyze the ultrasonographic features of axillary lymph node metastasis in breast cancer patients, and to evaluate the accuracy of these features by Receiver Operating Characteristic (ROC) curve.

METHODSUltrasonography was carried out in 113 patients (mean age 56.5 yr, range 29 - 77 yr). The ultrasonographic features of the primary tumor and the axillary lymph node were observed. Univariate analysis was performed by Chi-squared test and Fisher exact test, and multivariate analysis to determine independent significant individual variables by multiple logistic regression analysis. ROC curve analysis was done to determine the sensitivity and specificity of individual and combined ultrasonographic features in distinguishing metastatic lymph node from the normal one.

RESULTSThe primary tumor size, abundance of blood supply in the primary tumor, longitudinal-transverse diameter ratio, cortex-hilum thickness ratio (on the longitudinal section), abnormal cortex thickness, distribution of intra-nodal vascularity of axillary lymph nodes were found to be statistically significant factors by univariate analysis. The primary tumor size, longitudinal-transverse ratio and cortex-hilum thickness ratio of lymph node were proved to be significant independent predictors of axillary lymph node metastasis by logistic regression analysis. Through ROC analysis, the combination of these independent ultrasonographic feature predictors was found to contribute significantly in differentiating metastatic lymph node from the normal with a sensitivity of 88.6% and specificity of 84.5%.

CONCLUSIONAxillary ultrasonography is helpful in staging the axillary lymph node in breast cancer patient. The primary tumor size, longitudinal-transverse diameter ratio and cortex-hilum thickness ratio of lymph node are the main features to determine whether metastatic involvement is present or not.

Adult ; Aged ; Axilla ; Breast Neoplasms ; diagnostic imaging ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; secondary ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Ultrasonography