Mammogram

Patient Jane had a circumscribed well defined margin mass on mammogram. Regarding circumscribed well defined margin breast lumps:
- circumscribed Breast lumps are always benign

- 5% carcinomas have circumscribed breast lumps

- halo sign reported is unhelpful in determining benignity

- sonar is useful to exclude cyst

- magnification compression views required - showing indistinct or microlobulated margins require biopsy

- solid masses that are well circumscribed on magnification views have a high probability of being benign, follow up in 6/12 months

- please exclude cysts, fibrosis, fibroadenoma, primary breast carcinoma, lymphoma and metastatic disease from malignant melanoma in circumscribed well defined margin breast lumps

- cysts, rare after menopause unless on hormone replacement therapy. US diagnosis required, frequently deformed with gentle pressure, orthogonal views required to rule out irregularities or masses from the cyst walls
- fibrosis, may have ill defined boarders
- fibroadenoma, look for popcorn calcifications, in 20 to 30 year old females, rare post menapause
- primary breast carcinoma, usually infiltrating ductal carcinoma, papillary carcinoma, mucinous carcinoma, medullary carcinoma
- lymphoma and
- metastatic disease, usually from melanoma

DENSITY
- fat is benign
- heterogenous non fatty masses are malignant

Fat density
- oil cysts, thin capsule, some architectural distortion,
- galactoceles during or post lactation from an obstructed milk duct

mixed water and fat density
- probably a hamartoma with a thin capsule, stable for years,
- intramammary lymphnodes - usually in the upper outer quadrant

Skin lesions - halo around one edge only

Multiple masses - represent fibroadenoma, cysts, or multiple papillomas
unifocal multiple masses on mammogram - consider metastasis