Meme İçinde Meme” mi? Meme Hamartomlarının Radyolojik Özellikleri

Year 2020, Volume: 25 Issue: 3, 237 - 242, 29.10.2020

Muhammed Akif Deniz , Zelal Taş Deniz , Aydın Aslan , Mehmet Turmak , Çağlayan Çakır

https://doi.org/10.21673/anadoluklin.718437

Abstract

Amaç: Bu çalışmada benign lezyonlar olan meme hamartomlarının (MH) radyolojik görüntüleme özelliklerini ele almak ve hamartom lezyonlarının tanınabilirliğini vurgulayarak gereksiz tetkik ve biyopsilerin azaltılmasına katkıda bulunmak amaçlanmıştır.

Gereç ve Yöntemler: Ocak 2014—Temmuz 2019 döneminde Dicle Üniversitesi Tıp Fakültesi radyoloji kliniğimizde MH tanısı almış olan toplam 33 (32 kadın, 1 erkek) hastanın mamografi (MG), ultrason (US) ve manyetik rezonans görüntüleme (MRG) görüntüleri retrospektif olarak incelendi. Altı hastanın MG, US ve MRG, 21 hastanın MG ve US, 6 hastanın ise sadece MRG görüntüleri mevcuttu. Erkek hasta için MG ve US görüntüleri mevcuttu.

Bulgular: Ortalama hasta yaşı 48,5 (28–74) yıldı. Ortalama kitle boyutu 3,4 (1,5–12) cm idi. En büyük kitle jinekomasti ön tanısı ile kabul edilen erkek hastada olup sol memeyi tamamen kaplamıştı. Lezyonlar 20 hastada sağ, diğer 13 hastada sol meme yerleşimliydi. MRG görüntüleri incelendiğinde postkontrast görüntülerde lezyonların tamamında periferal ağırlıklı heterojen kontrastlanma mevcutken kontrastlı serilerde 10 hastada tip 1, 2 hastada tip 2 kinetik eğri mevcuttu. Hiçbir hastada tip 3 kinetik eğri saptanmadı. Normal meme dokusu görünür difüzyon katsayısı (GDK) değeri ile hamartom GDK değeri arasında istatistiksel olarak anlamlı fark bulunmadı (p>0,5).

Tartışma ve Sonuç: Benign lezyonlar olan MH’ler radyolojik incelemelerde memeye benzer özellikte küçük nodüler lezyonlar şeklinde izlenirler ve bu özellikleriyle “meme içinde meme” görünümü verdiklerinden kolaylıkla tanınabilirler.

Keywords

Hamartom, Meme içinde meme, Mamografi, manyetik rezonans görüntüleme, ultrasonografi

Supporting Institution

Yok

Project Number

Yok

“Breast within Breast”? Radiological Features of Breast Hamartomas

Abstract

Aim: In this study, we aimed to discuss radiological imaging features of breast hamartomas (BHs), which are benign lesions, and contribute to reducing unnecessary examinations and biopsies by emphasizing the recognizability of hamartoma lesions based on those features.

Materials and Methods: We retrospectively reviewed the mammography (MG), ultrasound (US), and magnetic resonance imaging (MRI) images of a total of 33 (32 females, 1 male) patients who were diagnosed with BH at our radiology clinic in the Dicle University Medical Faculty between January 2014 and July 2019. Six patients had MG, US, and MRI images, 21 had MG and US images, and 6 had only MRI images. For the male patient, MG and US images were available.

Results: The mean patient age was 48.5 (28–74) years. The mean mass size was 3.4 (1.5–12) cm. The male patient admitted with a pre-diagnosis of gynecomastia had the largest mass, which occupied the entire left breast. The lesions were located in the right breast in 20 patients and in the left breast in the remaining 13. When the MRI images were reviewed, post-contrast images showed peripheral heterogeneous contrast enhancement in all lesions while contrast-enhanced series showed type 1 and 2 kinetic curves in 10 and 2 patients, respectively. No type 3 kinetic curve was identified in any of the cases. No statistically significant difference was found between the normal breast tissue apparent diffusion coefficient (ADC) and hamartoma ADC values (p>0.5).

Discussion and Conclusion: BHs as benign lesions are seen in radiological examinations as small nodular lesions characteristically similar to the breast tissue, with the easily recognizable “breast within breast” appearance.

Keywords

Hamartoma, Breast within a breast sign, Mammography, magnetic resonance imaging, Ultrasonography

Project Number

Yok

References

• 1. Gatti G, Mazzarol G, Simsek S, Viale G, Peradze N, Luini A. Breast hamartoma: a case report. Breast Cancer Res Treat. 2005;89:145–7.
• 2. Herbert M, Sandbank J, Liokumovich P, Yanai O, Pappo I, Karni T, ve ark. Breast hamartomas: clinicopathological and immunohistochemical studies of 24 cases. Histopathology. 2002;41:30–4.
• 3. Dahnert W. Radiology Review Manual, 5. ed. Philadelphia: Lippincott; 2003:537–66.
• 4. Siegelman ES, Rosen MA. Tüm Vücut MRG, çev. Olgun DÇ. İstanbul: İstanbul Tıp Kitabevi; 2008:425–73.
• 5. Ortiz BM, Hernandez DB, Mateos CR, Garcia FJR. Benign breast diseases: clinical, radiological and pathological correlation. Ginecol Obstet Mex. 2002;70:613–8.
• 6. Watson L. Breast hamartoma. Radiol Technol. 2001;72:611–3.
• 7. Brinck U, Fischer U, Korabiowska M, Jutrowski M, Schauer A, Grabbe E. The variability of fibroadenoma in contrast-enhanced dynamic MR mammography. Am J Roentgenol. 1997;168:1331–4.
• 8. Temiz M, Aslan A, Bozkurtoğlu H, Atik E, Beyaz F, Canbolant E, ve ark. Fibroadenom ile karışabilen büyük meme hamartomu olgusu. Meme Sağlığı Derg. 2008;4:3.
• 9. Arrigoni MG, Dockerty MB, Judd ES. The identification and treatment of mammary hamartoma. Surg Gynecol Obstet. 1971;133:577–82.
• 10. Magdalene KF, Robin G, Sapna M. Mammary hamartoma—a clinical dilemma. Gulf J Oncolog. 2014;1:87–90.
• 11. Farrokh D, Hashemi J, Ansaripour E. Breast hamartoma: mammographic findings. Iran J Radiol. 2011;8:258–60.
• 12. Weinzweig N, Botts J, Marcus E. Giant hamartoma of the breast. Plast Reconstr Surg. 2001;107(5):1216–20.
• 13. Silva B, Rodrigues JS, Borges US. Large mammary hamartoma of axillary supernumerary breast tissue. Breast. 2006;15:135–6.
• 14. Latifoğlu O, Ayhan S, Cömert M, Yenidünya S, Çenetoğlu S, Atabay K. Asimetrik meme nedeni olarak hamartom: iki olgu sunumu. Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Derg. 1997;5(3):87–93.
• 15. Tse GMK, Law BKB, Ma TKF, Chan ABW, Pang LM, Chu WCW, ve ark. Hamartoma of the breast: a clinicopathological review. J Clin Pathol. 2002;55:951–4.
• 16. Oueslati S, Salem A, Chebbi A, Mhiri S, Kribi L, Rombhane BK, ve ark. Hamartome du sein. Imagerie de la Femme. 2007;17:19–25.
• 17. Fsiher JC, Hanby AM, Robinson L, Millis RR. Mammary hamartoma. A review of 35 cases. Histopatology. 1992;20:99–106.
• 18. Hogeman KE, Ostberg G. Three cases of postlactational breast tumor of peculiar type. Acta Pathol Microbiol Scand. 1968:73:169–76.
• 19. Linell F, Ostberg G, Soderstrom J, Andersson I, Hildell J, Ljungvist U. Breast hamartomas: an important entity in mammary pathology. Virchows Arch Path Anat and Histol. 1979:383:253–64.
• 20. Hesller C, Schnyder P, Ozello L. Hamartoma of the breast. Diagnostic observation of 16 cases. Radiology. 1978;126:95–8.
• 21. Farrokh D, Janbakhsh H, Ansaripour E. Breast hamartoma: mammographic findings. Iran J Radiol. 2011;8(4):258–60. 22. Masciadri N, Ferranti C. Benign breast lesions: ultrasound. J Ultrasound. 2011;14(2):55–65.
• 23. Cucci E, Santoro A, Di Gesu C, Ciuffreda M, Maselli G, Pierro A, ve ark. Integrated imaging of breast hamartoma: two case reports. Breast Dis. 2015;35(1):53–7.
• 24. Erdem G, Karakas HM, Işık B, Fırat AK. Advanced MRI findings in patients with breast hamartomas. Diagn Interv Radiol. 2011;17(1):33–7.
• 25. Ravakhah K, Javadi N, Simms R. Hamartoma of the breast in a man: first case report. Breast J. 2001;7:266–8.
• 26. Deshpande A, Munshi M. Mammary hamartoma: report of two cases including one in a male breast, and review of the literature. Indian J Pathol Microbiol. 2004;47:511–5.
• 27. Khadilkar V, Jehagirdar R. Breast hamartoma presenting as prepubertal gynecomastia. Indian Pediatr. 2009;46:446–7.