Sonography is a diagnostic method that can help establish the differentiation between benign and malignant solid tumors. A lack of circumscribed margins, heterogeneous echo patterns, thickened Cooper ligaments, and an increased anteroposterior dimension can indicate a higher probability of malignancy in solid breast nodules.

To create an individualized predictive tool for the risk of malignancy in solid breast masses, based on echographic and clinical characteristics. Research Ethics Committee approval and informed consent were obtained. This multi-center study included 1,403 solid breast masses prospectively. Each ultrasound feature was analyzed and compared with the definitive diagnosis. The ultrasound results, women's ages and family histories of breast cancer were included in a multivariate logistic regression model. Among the 1,403 lesions included in the study, 1,390 (99.1%) had a conclusive diagnosis: 343 malignant tumors (24.7%), and 1,047 benign masses (75.3%). The odds ratio (and confidence interval) for breast malignancy for each variable included in the model, as calculated by multivariate analysis, were as follows: irregular shape/noncircumscribed margins, 16.02 (7.75-33.09); heterogeneous echo texture, 4.50 (2.42-8.23); vertical orientation (not parallel to the skin), 2.23 (1.04-4.75); anterior echogenic rim, 2.62 (1.09-6.31); posterior shadowing, 2.38 (1.23-4.62); age more than 40 years, 2.19 (1.26-3.81); positive first-degree family history (mother, sister or daughter), 7.50 (2.65-21.18). There was no advantage in including the presence of internal vascularity, presence of thickened Cooper's ligaments or size of the mass, in the model. The predictive tool was named SONOBREAST and it is freely available for medical purposes on the internet site: http://www.sonobreast.com. The probability of malignancy in breast masses can be specified based on their ultrasound features, the woman's age and the family history of breast cancer.

Resultados: dentre as 142 pacientes incluídas no estudo, 90 (63%) tiveram suas lesões ressecadas, com diagnóstico de 77 tumores benignos (86%) e 13 de malignos (14%). Foram significantes no diagnóstico de malignidade as seguintes características ultra-sonográficas: presença de sombra acústica posterior (p=0,0001), contornos irregulares (p=0,0007), ecos internos heterogêneos (p=0,0015) e diâmetro ântero-posterior (AP) maior que o látero-lateral (LL) (p<0,0001). A presença de halo ecogênico no tumor e a visibilização dos ligamentos de. Por outro lado, alguns países desenvolvidos já estão conseguindo reduções significativas em suas taxas de mortalidade por câncer de mama. Acredita-se que essa redução seja devida principalmente ao seu diagnós-tico precoce e às novas opções terapêuticas 1,3 . Com relação ao diagnóstico precoce das neoplasias mamárias, a popularização dos programas de rastreamento mamográfico tem recebido o maior destaque nos meios científicos. Em recente meta-análise com os oito maiores estudos Trabalhos Originais 24 (3): 195-199, 2002 RBGO

Pseudoangiomatous stromal hyperplasia (PASH) is a wellrecognized but poorly understood entity that was initially described in 1986. 1 It has two forms of presentation: as focal expression within the context of other breast lesions or, in rarer situations, as well-defined palpable tumors, with fibroelastic consistency, similar to fibroadenoma or to phyllodes tumors. 2 The tumoral form is infrequent, occurring mainly during the third and fourth decades of life. 3 Because of the rarity of PASH tumors and uncertainty about their clinical behavior, surgical excision has been the recommended treatment. 4 Recently, a series of 12 pediatric patients with PASH was reported, including a 3-year-old boy. PASH was found in 12% of tumors diagnosed preoperatively as fibroadenomas and in 12% of cases diagnosed preoperatively as gynecomastia. 5 The objective of this letter was to report on a case of PASH in a 9-month-old female patient who was referred due to rapid and painless tumor development in the right breast. On physical examination a well-defined nodule of hardened consistency, with little mobility, measuring 5.5 cm, was noted. The child's development to that point had been normal.Ultrasound indicated a peri-areolar hypoechogenic nodule, at 9 o'clock in the right breast, measuring 2.5 ¥ 1.0 cm. It had heterogeneous content and unclear borders, with no posterior shadowing.A core biopsy was performed under sedation and local anesthetic. On histology the presence of breast tissue was noted, with well-defined lesions formed by homogeneous fibrous tissue, without hemorrhagic areas or necrosis, with spaces of fissure type covered by flattened fusiform cells that resembled vascular channels, in both the inter and the intra-lobular stroma. Cell pleomorphism and karyokinetic activity were not observed (Fig. 1a). On immunohistochemistry, avidin-biotin-peroxidase staining was negative for factor VIII and desmin, and positive for CD34 (Fig. 1b) and vimentin (Fig. 1c).Because of the patient's age, it was decided to manage the case expectantly, without performing excision, in order not to alter the breast bud. Two years later, the patient remained asymptomatic. Clinical examination did not show any increase in tumor formation, but early thelarche was observed in the affected

We present the case of a 52-year-old female who developed sudden, uncomfortable swelling in her right (reconstructed) breast and small, smooth, firm, mobile nodules with mastitis-like symptoms and without skin ulceration. Image studies and histo-cytopathology examination confirmed the presence breast implantassociated anaplastic large cell lymphoma. The patient was treated with implant removal.