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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5791_Библиотеки_им_академика_М_И_Перельмана.pdf
162
Fig. 7.9 (continued)
7 Differential Diagnosis of Breast Diseases
Posterior echo enhancement •
Easy deformation and painlessness with •
compression
Avascularity with CDI, PDI, and 3DPD •
Absence of color pattern within the lesion •
with US elastography
Up to 95 % of breast cysts have no solid component on the capsule (Korzhenkova 2004 ) . Such
cysts are characterized as simple (typical) and
uncomplicated. There are also breast microcysts
(with the size of 1–2 mm), macrocysts (simple
and multilocular), individual, and multiple
(Trufanov et al. 2009 ) .
Breast cysts in some cases may not exhibit
such a characteristic symptom as posterior echo
enhancement. This happens more often in small
cysts, the cysts surrounded by dense structures,
near to the thorax, or in cysts with expressed
fi brous capsule (Zabolotskaya 2006 ) .
Atypical cysts may be sometimes observed
among fl uid breast lesions ( Sergeeva and
Sotskova 2009 ) . They confer long-existing,
1637.2 Non-tumoral Diseases
Fig. 7.10 Simple breast cyst. Sonograms. Gray scale, CDI, PDI, panoramic scan, 3DPD, and US elastography
164
Fig. 7.10 (continued)
7 Differential Diagnosis of Breast Diseases
1657.2 Non-tumoral Diseases
Fig. 7.10 (continued)
166
7 Differential Diagnosis of Breast Diseases
Fig. 7.10 (continued)
Fig. 7.11 Complex breast
cyst. Grayscale US
1677.2 Non-tumoral Diseases
recurrent cysts and cysts with in fl ammation
(Zabolotskaya 2006 ) .
US features of atypical cysts are listed below
(Fig. 7.11 ):
Thick cystic walls •
Contents with inclusions •
Solid component with different types of •
vascularization
Atypical US images of cysts in up to 2 % of
cases can be the result of intracavitary growth
originating from the cystic wall (Korzhenkova
2004 ) . Seventy- fi ve percent of them are papillomas of benign nature. Twenty percent of intracystic breast lesions are associated with papillary
cancer (Fig. 7.12 ). All kinds of growth con-
nected with cystic wall, especially if vascularized, demand US-guided biopsy with cytology
and are indicated for sector resection with urgent
histology.
Complex breast US permits easy cyst detection, characterization of their contents, wall
structure, and vascularity with the accuracy of
168
Fig. 7.12 Cystadenocarcinoma
of the breast. Grayscale US
7 Differential Diagnosis of Breast Diseases
95–100 % (Shevchenko 1997 , Sergeeva
2010 ) .
Atheroma is a retention cyst of the sebaceous
gland located in the benign skin and subdermal
tissues, which occurs by increased sweating of the
sebaceous gland, occlusion of its duct, and forming of a capsule around the fatty content. It
accounts for 0.2 % of all breast lesions (Rozhkova
1993 ) . Atheroma is clinically represented with a
dense formation with clear contours, painless, and
welded to the skin. Atheromas quite often in fl ame
and abscess. Local edema, hyperemia, morbidity,
and fl uctuation can be revealed in these cases.
Atheroma exhibits the following US features
(Fig.
7.13 ):
Hypoechoic or anechoic lesion •
Closely adjacent to the skin with scission of •
skin layers
Accurately boarded •
Avascular with CDI, PDI, and 3DPD •
Without color pattern with US elastography •
Complex diagnosis and differentiation of
breast lesions with careful analysis of obtained
US data and assessment of the effect of antibacterial and anti-in fl ammatory treatment often help to
rule out malignant process.
1697.2 Non-tumoral Diseases
Fig. 7.13 Atheroma. Sonograms. Gray scale, 3DPD, and US elastography
170
7 Differential Diagnosis of Breast Diseases
Fig. 7.13 (continued)
Age-Related Changes in Breast Structure: Breast Ultrasound in Children and Adolescents
8
Breasts have special US features in various ages.
Mammary glands start their development at the
sixth week of embryogenesis. In a 5-month embryo,
mammary sprouts begin to ramify into a small
number of ductules. They also develop a lumen
with an opening to the skin, marked by the formation of the nipple sheath. Further development of
mammary glands is irregular. A signi fi cant number of newborn (both girls and boys) has enlargement and in fi ltration of mammary glands at the
fi rst week of life due to physiological mastopathy.
They are detected with US as masses of oblong
shape with normal echodensity without differentiation of structural elements. Super fi cial and deep
leaves of fascia, which “embrace” the gland, can
be clearly identi fi ed. The average dimensions of
the gland are 1.5 × 0.6 × 1.4 cm. This status usually
does not demand any treatment as in most cases it
spontaneously regresses within 2–3 weeks.
Two periods in childhood, at the ages of 4 and
9, exhibit an increase in the number of glandular
structures. Normally, distinct breast enlargement
occurs at the age of 11–13 years. In some cases,
the enlargement of mammary glands in girls of
5–7 years or 7–9 years may be observed in the
absence of the clinical and laboratory data of precocious puberty. It is regarded as isolated premature thelarche. The dimensions and structure of
the breast in these girls do not differ from those
of the newborn with physiological mastopathy.
Beginning with 10–11 years, the mammary
glands start to develop more intensively. Stromal
component often develops signi fi cantly faster
than the glandular tissue.
The greatest activity of mammogenesis is
registered with activation of growth and development of a female organism at the age from 11 to
25 years. The fi rst wave of breast development
comes at 12–14 years; the second, 2–3 years
later; and then 5–7 years later. It is noticed that if
the second wave is absent, the degree of mammary gland development appears very low.
In puberty, fi brous and adipose stroma start to
develop earlier than glandular tissue. It confers
two types: supporting stroma and periglandular
stroma. Breast enlargement in girls of 11–13
years (prior to menarche) is accompanied with
signi fi cant changes in its structure. US reveals
layers of low echodensity of 0.1–0.3 cm thick,
which alternate with thin layers of high echodensity (Fig. 8.1 ).
The layers of low echodensity merge in subareolar area and form a region of irregular shape.
Therefore, US fails to differentiate glandular tissue from periglandular stroma in most cases. The
expression of periglandular stroma corresponds
to the development of glandular tissue.
In puberty, at 12–16 years of age, the breasts
continue to develop glandular tissue. The morphological feature of mammary glands in girls of 14–16
years is the formation of new structures – tubular
lobules. Breasts in girls of this age after menarche
exhibit “reticular” structure with US. Transverse
scanning demonstrates areas of decreased echodensity of 0.1 cm (small-cell type), 0.2 cm (middle-cell
type), or 0.3 cm (large-cell type) in size surrounded
with layers of high echodensity. Longitudinal scanning of these areas reveals their elongated shape.
A.N. Sencha et al., Breast Ultrasound,
DOI 10.1007/978-3-642-36502-7_8, © Springer-Verlag Berlin Heidelberg 2013
171