MRI diagnosis and follow‐up of chest wall and breast desmoid tumours in patients with a history of oncologic breast surgery and silicone implants: A pictorial report

Abstract

Introduction: Breast and chest wall desmoid tumours can cause debilitating symptoms and deformity. The mutilating effects of surgical treatment have prompted a shift to medical treatments and even to a wait-and-see approach.This study sought to highlight specific characteristics of breast and chest wall desmoid tumours on long-term follow-up by sequential MRI scans. Methods: Thirty-two breast MRI scans from six patients with chest wall or breast desmoid tumours followed up for up to 6 years were retrospectively reviewed. Results: All patients underwent breast surgery prior to the development of the desmoid tumour. Five of the patients had reconstruction or augmentation using silicone implants. Two desmoids were treated primarily with surgery, three with medical means and one is under wait-and-see approach. On MRI, tumours appeared either oval and lobulated (chest wall) or spiculated with architectural distortion (breast). Chest wall desmoids demonstrated both an enhancing high-T2-signal component and a non-enhancing low-T2-signal component. The histologically defined phases during the course of desmoid tumours (progression, regression, residual disease) could be demonstrated by corresponding MRI changes in each of the components. Conclusions: Magnetic resonance imaging delineates the complex infiltrative features of chest wall and breast desmoid tumours. In tumours with a bright cellular enhancing and dark collagenous non-enhancing component, treatment response may be predicted by changes on serial T2-weighted sequences, beyond the tumour-dimension-based RECIST assessment alone.

Desmoid Tumor and Implant-Based Breast Reconstruction

“…MRI can be both diagnostic and useful for preoperative planning. Breast desmoid tumors are isointense masses on T1-weighted images with either lower or higher intensity lesions seen on T2-weighted images and can be distinguished from chest wall desmoid tumors [6, 13].…”

“…Treatment for desmoid tumors has largely been surgical excision with microscopically negative margins; however, there has been a recent shift in paradigm to watchful waiting with or without medical treatment and intra-arterial chemoembolization [13, 14]. Preservation of function has become a hallmark of desmoid tumor treatment, favoring careful surveillance in cases of desmoid tumors where functional loss after surgical excision may be a major contributor to morbidity [14].…”

“…Preservation of function has become a hallmark of desmoid tumor treatment, favoring careful surveillance in cases of desmoid tumors where functional loss after surgical excision may be a major contributor to morbidity [14]. Spontaneous regression has also been noted in patients with current studies evaluating how the immunologic environment of the host may contribute to regression [13, 14]. Radiotherapy (with or without surgery) and medical immunotherapy have also been advocated as both treatment or adjuvant therapies to help control the progression of desmoid tumors, particularly when surgery may cause significant morbidity or when microscopic or gross surgical margins are positive [14].…”

“…Treatment for desmoid tumors has largely been surgical excision with microscopically negative margins; however, there has been a recent shift in paradigm to watchful waiting with or without medical treatment and intra-arterial chemoembolization [13,14]. Preservation of…”

Imaging of the Reconstructed Breast

“…They are best evaluated on MRI with two distinct features: chest wall tumors presenting as oval and lobulated masses, that are locally aggressive invading the intercostal muscles and pleura, and breast tumors presenting as spiculated masses. The masses are isointense to muscle at T1 images with variable T2 signal intensity and heterogeneous enhancement [102].…”