SONOWORLD : Inflammatory pseudotumor of the breast

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Breast » Breast

Inflammatory pseudotumor of the breast

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Presentation A 66-year-old woman presented with pain and swelling in her breast of 4 years duration. Breast imaging examinations from 2003 and 2004 are illustrated.

Caption: Cranio-caudal mammograms -year 2003

Description: A small nodule is seen in the right breast that is suspicious for malignancy. The left breast reveals a normal parenchymal architecture.

Caption: Comparative medio-lateral oblique views -year 2003

Description: The nodule is noted again in the upper quadrant of the right breast. The left breast appears normal.

Caption: Cranio-caudal views performed the subsequent year

Description: Post surgical changes are seen in the right breast as a result of removal of the nodule seen in images of the year 2003. The right breast now shows the development of a new nodule. The left breast shows 2 new nodules that were not seen previously.

Caption: Medio-lateral oblique views

Description: Post surgical changes are seen in the right breast. The appearance of new nodules in both the breasts as described previously is noted.

Caption: Ultrasound of one of the newly detected nodules

Description: Sonograms of all masses show solid masses with characteristics of malignancy.

Caption: Medio-lateral oblique views

Description: Post surgical changes are seen in the right breast. The appearance of new nodules in both the breasts as described previously is noted.

Differential Diagnosis Malignancy, inflammatory pseudotumor

Final Diagnosis Inflammatory pseudotumor

Discussion • Pertinent History: Approximately 20yrs ago, the patient experienced a pulmonary embolus and was treated with warfarin. She has recently been self medicating with large doses of Vitamin E 4000-8000 IU per day. The biopsy specimens had revealed fat necrosis and recent hemorrhage secondary to Vitamin E ingestion.
• The imaging and pathologic findings are compatible with Vitamin E induced hemorrhagic necrosis of the breast.
• To our knowledge this has not been reported in the literature, but has been submitted for publication by Vrcel et al from the Moffitt Cancer Center.

Case References 1. Belli P et al. Role of magnetic resonance imaging in the diagnosis of recurrence after breast conserving therapy. Rays. 2002 Oct-Dec; 27(4) 241-57
2. Ringberg et al. Ipsilateral local recurrence in relation to therapy and morphological characteristics in patients with ductal carcinoma in situ of the breast. Eur J Surg Oncl. 2000 Aug;26 (5) 444-51
3. Robyn L Birdwell and Roger J Jackman. Clip or marker migration 5-10 weeks after stereotactic 11 guage vacuum assisted breast biopsy – Report of 2 cases. Radiology 2003 229: 541-544

Follow Up Biopsies were performed in 2003 and 2004. The pathological diagnosis was inflammatory pseudotumor. Review of the pathology was made after further history was obtained from the patient.

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