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41 CHAPTER 5 Overview of Radiologic Aspects of Breast Disease A SKIN CHANGES Skin thickening is often accompanied by thickening of the Cooper’s ligaments. Skin and Cooper’s ligament thickening can be caused by tumor, inflammation or edema. Skin thickening is the mammographic correlate of the clinical sign ‘peau d’orange’ and may be seen in so called inflammatory breast cancer. Skin thickening is often seen associated with breast infections and when there is either venous or lymphatic obstruction within the axilla.

Histology confirmed a 43 mm lobular carcinoma with additional tumor foci behind the nipple. 48 pretation is based on the morphology of the abnormality as well as an assessment of how the lesion enhances following the injection of the MR contrast agent, gadolinium (Figure 5-17). Architectural features that indicate benign disease and malignancy are similar to those already described for mammography and ultrasound. Benign lesions tend to be well-defined with smooth margins whereas malignant lesions are poorlydefined and may show spiculation or parenchymal deformity.

In difficult cases, such as DCIS/LCIS involving areas of sclerosing adenosis, immunohistochemistry can be undertaken to assess whether a myoepithelial and basement membrane layer is indeed present. The finding of pure DCIS in a core does not, of course, preclude the finding of an invasive focus in the subsequent surgical excision sample and in approximately 20% of cases it has been reported that a co-existing invasive carcinoma will be seen. One of the benefits of core biopsy is that the diagnosis of special type and low grade carcinomas is not as problematic as this may be on FNAC (Figure 3-11).

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Aspects of the pathology of money: monetary essays from four decades by M.A. Heilperin


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