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Special Feature
February 01, 2007

Image of the Month—Quiz Case

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

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.

Figure 1.
Mammogram shows a dense mass without calcifications.

Mammogram shows a dense mass without calcifications.

Figure 2.
Gadolinium contrast-enhanced image revealed an intense ring-enhancing mass with large arteries and veins going to the mass.

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

What Is the Diagnosis?

A. Phyllodes tumor

B. Angiosarcoma

C. Hamartoma

D. Fibroadenoma

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