Desmoid Type Fibromatosis of the Breast Masquerading as Breast Carcinoma: Value of Dynamic Magnetic Resonance Imaging and Its Correlation

Abstract

Desmoid type fibromatosis of the breast is a rare stromal tumor that accounts for <0.2% of all breast tumors. Although benign, this tumor is locally aggressive with frequent recurrence in up to almost one-third of the cases (1). Bilateral and multicentric lesions are extremely rare, found in only 4% of patients, with only less than ten cases reported in the literature (1, 2). Imaging features of aggressive fibromatosis can frequently mimic invasive breast cancer, resulting in exhaustive clinical and surgical workups. Case PresentationA 19-year-old woman, with a familial history of breast cancer (paternal aunt diagnosed with it at age 30), presented with bilateral breast lumps that were increasing in size and associated with nipple retraction for one year. Physical examination revealed bilateral retracted nipples. There was a 4 cm × 5 cm firm, ill-defined, mobile retroareolar mass in her right breast and a 3 cm × 3 cm firm, ill-defined, mobile mass in the upper outer quadrant of her left breast. There were no skin changes and fixation to the chest wall or skin. Axillary, supraclavicular, and infraclavicular lymph nodes were not palpable. Breast ultrasound showed bilateral ill-defined hypoechoic masses (two on the right, one on the left) with irregular margins and posterior shadowing (Figure 1).

Breast-Implant-Related Fibromatosis in a Patient with Free Silicone Injection: a Case Report

“…More common features include hypoechogenicity, irregular border and posterior acoustic shadowing. [4][5][6]14 Similar to its clinical presentation, these radiological features show a lot of overlap with breast cancer and commonly point towards malignancy after completion of triple assessment. Unique to our patient, mammogram and ultrasound played a very limited role in assessment of the lesion as the presence of free silicone largely obscured the index lesion, but these modalities clarified the nature of the previously unknown injected material.…”

“…5 Clinically, similar to our case, patients with breast fibromatosis are commonly reported to present with a unilateral solitary mass, but bilateral or even multicentric disease has been reported. 6,14 Non-palpable disease has also been detected on screening mammogram. 4 The mass is usually firm or hard and can be mobile or fixed to the chest wall.…”

“…4 The mass is usually firm or hard and can be mobile or fixed to the chest wall. 6,14 Nipple retraction and skin changes have also been reported, which are features that raise a suspicion of malignancy. 4,6,14 It can be slow or rapidly growing.…”

“…6,14 Nipple retraction and skin changes have also been reported, which are features that raise a suspicion of malignancy. 4,6,14 It can be slow or rapidly growing. Since it is not metastasising, lymphadenopathy is not a feature.…”

“…Calcifications are rare. [4][5][6]12,14 On ultrasound, features likewise vary, ranging from a circumscribed parallel mass to a non-parallel hypoechoic mass with obscured, irregular or spiculated borders. More common features include hypoechogenicity, irregular border and posterior acoustic shadowing.…”