Teaching Files
Archived Case 18
Contributed by: Katherine E. Dee, MD -
Is an ultrasound necessary?
YesNo
This mass is suspicious and warrants a biopsy regardless of what an ultrasound shows; however, an ultrasound was performed so that a biopsy might be done under ultrasound guidance.
What is the most likely diagnosis?
FibroadenomaPapilloma
Phylloides tumor
Breast carcinoma
Metastatic ovarian carcinoma
This patient had known ovarian carcinoma, and the biopsy showed metastatic ovarian carcinoma, but the differential diagnosis included a primary breast cancer. The diffuse calcifications are more typical of the psammomatous calcifications seen with ovarian tumors. In fact, when primary breast tumors are the papillary type and have multiple calcifications, the pathologist may include ovarian metastasis in the differential after core biopsy.
These are not the typical pop-corn or coarse calcifications one sees with fibroadenomas. Phylloides tumors do not have typical calcifications. Papillomas do occasionally have diffuse calcifications, so this answer is possible, but less likely.
The calcifications really make the mass look echogenic on ultrasound. Hyperechogenicity is a benign ultrasound characteristic. It is important to remember that when a mass is suspicious by mammography, one cannot back away from a biopsy because of a benign ultrasound appearance