2020 Volume 47 Issue 3 Pages 129-135
A woman in her 60s presented with a left breast tumor in December. No abnormality was identified during breast cancer screening performed the previous year. A poorly movable mass (2 cm in diameter), which was elastic firm and had an irregular and indistinct border, located at the 12 o’clock position (A/C area) in the left breast was identified by palpation. Mammography findings were category I. Breast B-mode ultrasonography revealed a tumor (19×10×16 mm) with an irregular shape, well-defined and rough border, hypoechoic heterogenous internal echo with cystic change, no change in posterior echoes, no interruption of the interface between adipose tissue and the gland, and D/W 0.53. Doppler ultrasonography revealed a tumor without blood flow signals. Contrast-enhanced computed tomography scan showed a heterogeneous nodule of about 10 mm in diameter gradually becoming enhanced in the CD area, a finding which is consistent with breast cancer. We first suspected breast cancer, but the pathological diagnosis based on a needle biopsy was xanthogranulomatous inflammatory lesions consisting of chronic inflammatory cells and macrophages, and tumor cells were not identified by additional immunostaining. Ultrasonography was performed in May the next year for follow-up purposes, and the tumor diameter and depth width ratio were confirmed to have decreased to 16×7×14 mm and 0.44, respectively. Compared with the previous shape, the central part of the tumor dimpled and the protrusion towards the front disappeared. Although an internal echo showed uneven low echoes and linear high echoes, the cystic region disappeared and changed to images suggestive of benign disease. Xanthogranulomatous inflammation is a very rare disease, and is difficult to distinguish from malignancy based on image examination. We thus report this case with a review of the literature, focusing on changes in ultrasonographic findings.
