isoechoic mass on ultrasound

Ann Surg Oncol 16(9):25872593, Bonvalot S, Terns N, Fiore M et al (2013) Spontaneous regression of primary abdominal wall desmoid tumors: more common than previously thought. Iran J Radiol 13(3):e20873, PubMed Radiol Case Rep 10(2):1116, Scaranelo A, Bukhanov K, Crystal P, Mulligan AM, Omalley FP, (2007) Granular cell tumour of the breast: MRI findings and review of the literature. . No evidence of malignancy. Although it can coexist with malignant lesions [49, 50], PASH itself is a benign entity without an increased risk for malignancy [51]. There are . Stromal fibrosis in the breast is a benign pathologic entity characterized by proliferation of stroma with obliteration of the mammary acini and ducts on pathologic analysis. This process results in a localized area of fibrous tissue associated with hypoplastic mammary ducts and lobules. Guirguis, M.S., Adrada, B., Santiago, L. et al. also what is a heterogenous nodule with tiny cystic spaces, it measures 0.7cm? The standard treatment for desmoid fibromatosis is surgical excision with wide margins, particularly in cases of tumor growth or progressive disease [70,71,72,73,74,75]. The main differential is: liposarcoma: low-grade tumors are difficult to differentiate from lipomas, and can have a relatively benign clinical course but suffer from a high rate of recurrence 1. Variable appearance: May be homogenous hyper-, hypo-, or isoechoic lesion ; Central hyperechoic area (central scar) Hypo- or isodense on noncontrast imaging with a central scar ; Hyperdense during the arterial phase ; Typically isodense during the portal venous phase, although the central scar may become hyperdense as contrast diffuses into the . Lateral spot compression mammogram (a) shows an irregular, high-density mass with spiculated margins adjacent to the chest wall (arrow). The ultrasound appearances of liposarcomas tend to fall into three categories. Granulomatous mastitis typically affects parous women of childbearing age, often within 6months of pregnancy, although the timing of onset after pregnancy can vary widely and has been reported to be as long as 9years post-partum in some cases [10]. Any fatty tumor deeper than the subcutaneous tissues may be a liposarcoma and warrants MRI evaluation. Lipoma. Tubular adenoma is a rare benign tumor of the breast representing 0.13%-2.9% of all benign breast neoplasms [56,57,58]. Uterine leiomyoma | Radiology Reference Article | Radiopaedia.org 2023 BioMed Central Ltd unless otherwise stated. Bilateral craniocaudal mammogram (a) shows bilateral non-calcified, obscured masses correlating with the palpable triangular markers (arrows). Isoechoic mean | HealthTap Online Doctor Often hypoechoic and peripheral zone lesions are the only areas sampled. Repeat biopsy under MRI guidance confirmed the diagnosis of fat necrosis. The imaging features of desmoid fibromatosis are often indistinguishable from those of malignancy. This is exemplified in women with dense breast tissue, where USG is useful in detecting small breast cancers that are not detected on mammography. Ultrasound is ideal for guiding soft tissue biopsy or aspiration, especially when the mass is small and superficial. The ultrasound features of deeper lipomas are more variable and diagnosis less accurate. Like fibroadenomas, tubular adenomas are not known to increase the risk of cancer, and in contrast to fibroadenomas, are not associated with pregnancy or oral contraceptiveuse [59, 60]. statement and Ultrasound is less expensive and more accessible than magnetic resonance imaging (MRI). Several less common benign lipomatous masses deserve brief comment. Abstract. INTRODUCTION While there are many types of solid renal tumors; the most common solid renal masses are renal cell carcinomas (RCCs), angiomyolipomas (AMLs), and oncocytomas. Grayscale transverse (c) and longitudinal (d) ultrasound show a mixed-echogenicity oval mass correlating with the mammographic finding (arrows). Urology 52 years experience. N Am J Med Sci 6(5):219, Salemis NS, Gemenetzis G, Karagkiouzis G et al (2012) Tubular adenoma of the breast: a rare presentation and review of the literature. A mass that originates in other soft tissues could be benign or malignant. Clin Radiol 57(11):10011006, Poyraz N, Emlik GD, Batur A, Gundes E, Keskin S (2016) Magnetic resonance imaging features of idiopathic granulomatous mastitis: a retrospective analysis. A 47-year-old premenopausal woman was referred to our hospital with a 2 years history of mass and distortion of her left breast and with recent worsening of her symptoms. They are likely to have been present for many years and may change size with weight fluctuation. Axial post-contrast T1-weighted MRI (d), sagittal T2-weighted MRI (e), and postcontrast subtraction T1-weighted MRI (f) show two T2-hyperintense, rim-enhancing masses (arrows). Lipomas containing metaplastic cartilage or bone are called chondrolipomas or osteolipomas respectively 10. Renal Tumors | Radiology Key The patient presented 2years later with a contralateral palpable breast mass and nipple inversion. Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts, most common between the ages of 20 and 40 years. Insights Imaging 12, 53 (2021). Size and location should be described. The first critical distinction is to determine whether the mass originates from a synovial space (joint, bursa, or tendon sheath), as such masses are likely benign and related to a synovial process. Once concordance of the biopsy results is established, granulomatous mastitis is traditionally treated with corticosteroids or surgical intervention, such as wide local excision of localized disease or rarely mastectomy when the disease is extensive and resistant to corticosteroid therapy [19]. Pathol Res Pract 190(4):362371, Adrada BE, Krishnamurthy S, Carkaci S, Posleman-Monetto FE, Ewere A, Whitman GJ (2015) Unusual benign tumors of the breast. AJR Am J Roentgenol 173(2):317320, Yilmaz E, Lebe B, Usal C, Balci P (2001) Mammographic and sonographic findings in the diagnosis of idiopathic granulomatous mastitis. Grayscale (c) and color Doppler (d) breast ultrasound reveals a vascular heterogeneous mass (arrows). The risk factors for nonpuerperal breast abscesses are thought to include smoking and diabetes [3, 4]. PubMedGoogle Scholar. Eur Radiol 11(11):22362240, Memis A, Bilgen I, Ustun EE, Ozdemir N, Erhan Y, Kapkac M (2002) Granulomatous mastitis: imaging findings with histopathologic correlation. Google Scholar, Going JJ, Anderson TJ, Wilkinson S, Chetty U (1987) Granulomatous lobular mastitis. Patients typically present in adulthood (5th-7thdecades). As a malignant mass enlarges, especially if high grade, it becomes more heterogeneous with hypoechoic areas of internal necrosis and increased flow on color and power Doppler imaging. Insights into Imaging The Desmoid Working Group and European Society for Medical Oncology have provided additional guidance, adding the possibility of active surveillance to the above-stated treatment choices with the supervision of a multidisciplinary team experienced in desmoid fibromatosis tumors. Excessive pressure may obscure the margins of a soft tissue mass or compress a fluid component. Recurrence has been reported in patients who undergo surgical excision [21]. Isoechoic: is a descriptive term that means the lesion is similar in grayness/brightness to adjacent liver tissue. It has also been described in men in association with gynecomastia [26, 27]. Determining concordance can be challenging, especially on MRI-guided biopsies where the target may not remain visible and adequacy of sampling may be difficult to judge. 9. 2014;52(6):1295-305. Lymph node involvement in lymphoma has an appearance that it is consistent with malignant infiltration but is otherwise nonspecific, including enlargement, a round rather than oval shape, thickening of the node cortex, and narrowing or obliteration of the echogenic hilum. 2b, c). in general terms, benign lesions compress with transducer pressure and malignant lesions displace the breast tissue without changing in height; this is the basis for elastography Benign characteristics (with negative predictive values) well circumscribed, hyperechoic tissue: ~100% wider than deep: 99% By using this website, you agree to our 2002;224(1):99-104. Mimickers of breast malignancy: imaging findings, pathologic concordance and clinical management, https://doi.org/10.1186/s13244-021-00991-x, http://creativecommons.org/licenses/by/4.0/. Breast abscesses typically demonstrate a thick echogenic rim and increased vascularity, suggesting malignancy [2]. Terms and Conditions, 1 Ultrasound differentiates cystic from solid masses, which often require biopsy to exclude malignancy, 2 and can identify superficial soft tissue tumor margins and local tumor spread. We report a case of isoechoic axillary lymph node metastasis of mucinous carcinoma (so-called pure mucinous carcinoma) of the breast. 2a) [2]. Authors W J Ellis . Pathology The etiology of lipomas is unknown 10 . 6. MRI is the modality of choice to assess extent of disease and to evaluate for chest wall involvement [68, 69]. Ultrasonography can be used to assess size, depth, solid or cystic nature, and associated vasculature. Presence of T2-hyperintense slit-like spaces with cystic components favors the PASH diagnosis favors the diagnosis of PASH (Fig. A mass must be seen in two different planes during 2D ultrasound and in three planes during 3D ultrasound. 2004;24(5):1433-66. It is defined as a . Ultrasound. Mediolateral, craniocaudal, and spot tangential mammographic views do not reveal an abnormality (ac, respectively). The characteristic ultrasound appearance is a solitary complex cystic mass with a well-defined thick fibrous capsule, internal septations, mural nodularity and, occasionally, capsular calcification (Figure 4). T1-weighted non-fat-suppressed ( c ) and T1-weighted fat-suppressed ( d ) post-contrast MRI images show a well-circumscribed, heterogeneously enhancing breast mass suspicious for a sarcoma (arrow). Establishing a close relationship with the pathologist is essential to assess adequacy of the sample and whether repeat biopsy is indicated. While ultrasound is primarily used to discriminate between cystic and solid masses, there are often features that can limit the differential diagnosis. Although granular cell tumors are benign, wide local surgical excision is indicated owing to their locally infiltrative nature [75, 80]. Most malignant masses are predominantly hypoechoic, usually with low-level echoes or heterogeneity, and well defined as they have pseudocapsules. Histology demonstrates mature adipocytes with no cellular atypia or pleomorphism 4. The clinical presentation of several benign breast conditions, common and rare, can mimic breast cancer. Additional history gained during the ultrasound examination often adds insight to narrow the differential diagnosis. Ann Oncol 28(10):23992408, Duazo-Cassin L, Le Guellec S, Lusque A et al (2019) Breast desmoid tumor management in France: toward a new strategy. J Nucl Med 39(8):13981401, Brown AC, Audisio RA, Regitnig P (2011) Granular cell tumour of the breast. The Society of Radiologists in Ultrasound convened a panel of specialists from radiology, orthopedic surgery, and pathology to arrive at a consensus regarding the management of superficial soft-tissue masses imaged with US. Breast MRI sagittal post-contrast T1-weighted delayed images (e) and axial post-contrast T1-weighted images (f) show irregular enhancing masses (arrows). : If living up to > 50, some 35-50% of persons will develop small cysts in kidneys, which display themselves as isoechoic mass. PubMed Google Scholar, Rieber A, Tomczak RJ, Mergo PJ, Wenzel V, Zeitler H, Brambs HJ (1997) MRI of the breast in the differential diagnosis of mastitis versus inflammatory carcinoma and follow-up. Architectural distortion can also be an imaging feature of sclerosing adenosis. Development of desmoid fibromatosis is associated with trauma, surgery, and Gardner syndrome [63, 64]. 5. Pseudoangiomatous stromal hyperplasia. PubMed Central These masses can sometimes be continuous and can appear tubular. The management of sclerosing adenosis ultimately relies once again on the imaging features. We have classified mimickers of breast cancer into three groups: inflammatory breast conditions, proliferative breast conditions, and benign breast tumors (Fig. Granulomatous mastitis is an inflammatory breast condition of unknown etiology. In the presence of tumor growth or progressive disease, surgery remains the gold standard [69, 72,73,74]. Ultrasound-guided biopsy showed fat necrosis. What is a isoechoic A member asked: What is a innocuous and isoechoic thyroid nodule. A 36-year-old woman presented with a palpable breast mass. In certain locations, other fatty masses should be considered: retroperitoneum, e.g. J Clin Pathol 35(9):941945, CAS Confirmation of a malignant tumor typically initiates staging with thoracic computed tomography (CT) and possibly an isotope bone scan to identify potential metastases. It is important to note that stromal fibrosis can be seen in the setting of malignancy and has a reported upgrade rate to malignancy of 7% [35]. Hamartomas are uncommon, slow-growing tumors that represent 4.8% of benign breast tumors [38,39,40]. They are common, have a prevalence of 2.1%, and account for nearly half of all soft tissue masses. isoechoic, i.e. Jamshid Tehranzadeh. Sclerosing adenosis. . If the radiographic presentation is of a circumscribed mass or amorphous or punctate calcifications in a grouped distribution with adequate sampling, a pathologic diagnosis of sclerosing adenosis can be considered concordant. Folpe AR, Fritchie K, Goldblum J, Mertens F, Lipoma. Figure 1: histology - spindle cell lipoma, Case 20: subcutaneous lipoma in nape of neck, Case 28: lipoma causing posterior interosseous neuropathy, Case 35: erector spinae intramuscular lipoma, Post traumatic fat necrosis of the anterior abdominal wall, View Frank Gaillard's current disclosures, View Ashesh Ishwarlal Ranchod's current disclosures, see full revision history and disclosures, WHO classification of soft tissue and bone tumors (5th edition), lipoma vs well-differentiated liposarcoma. Floating the transducer on a thick layer of gel helps to demonstrate soft tissue swelling or a very superficial mass. Murphey M, Carroll J, Flemming D, Pope T, Gannon F, Kransdorf M. From the Archives of the AFIP: Benign Musculoskeletal Lipomatous Lesions. 1994 Dec;152(6 Pt 2):2304-7. doi: 10.1016/s0022-5347(17)31663-4. Histologically, the differential diagnosis includes a low-grade angiosarcoma and phyllodes tumor [46]. On physical examination, it can present as a fixed, painless, palpable mass with associated skin dimpling. The purpose of this review is to illustrate the wide spectrum of imaging features that can be associated with benign breast diseases with an emphasis on the suspicious imaging findings associated with these benign conditions that can mimic cancer. What is Isoechoic in ultrasound? - Wise-Answer A: An isoechoic mass in the periphery of the left kidney was initially missed. Sclerosing adenosis is often seen in perimenopausal women and can coexist with other benign proliferative lesions such as sclerosing papilloma, and complex sclerosing lesions [37]. A hypervascular soft tissue mass with preserved architecture suggests lymphoma. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Ranchod A, Niknejad M, et al. In lactating patients, although mammography is initially delayed until the acute symptoms of mastitis resolve following a course of antibiotics, mammography is indicated when there is a clinical suspicion for malignancy and in those with a prolonged clinical course [5, 6]. Granular cell tumor has a predilection for premenopausal and African American women and is preferentially found in the upper inner quadrants of the breast. Reference article, Radiopaedia.org (Accessed on 28 Jun 2023) https://doi.org/10.53347/rID-7654, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":7654,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/lipoma/questions/2578?lang=us"}. J Orthop Sci. Breast abscess. 3f). A 35-year-old woman presented with a palpable breast mass. Epididymal lesions | Radiology Reference Article | Radiopaedia.org Location not only includes the anatomical site but whether the mass is superficial or deep, intramuscular, etc. Stromal fibrosis. All biopsies showed dense stromal fibrosis, chronic inflammation, and features suggestive of granulomatous mastitis without atypia or malignancy. If the lesions combine other features of malignancy such as spiculated margin, nonparallel orientation and posterior shadowing, they are considered moderate and highly suspicious for malignancy (BI-RADS categories 4b and 4c) or highly suggestive of malignancy (BI-RADS category 5). On sonography, it frequently presents as a hypoechoic irregular mass with posterior acoustic shadowing or an area of shadowing without a discrete mass (Fig. AJR Am J Roentgenol. The reason why any lesion is visible on mammography or USG is the relative difference in the density and acoustic impedance of the lesion, respectively, as compared to the surrounding breast tissue. Therefore, evaluation of sampling adequacy and establishing radiologic-pathologic correlation in these cases is of utmost importance. Color Doppler (a) and longitudinal panoramic ultrasound grayscale images (b) show a hypervascular, 17-cm isoechoic breast mass replacing the entire breast. Contrast-enhanced ultrasound images. Breast J 13(6):607613, Pereira MA, de Magalhes AV, da Motta LD et al (2010) Fibrous mastopathy: clinical, imaging, and histopathologic findings of 31 cases. Mammographically, a hamartoma has a characteristic benign appearance of a fat-containing circumscribed mass. The masses can demonstrate variable shapes and kinetics. Hyperechoic breast images: all that glitters is not gold! 12d) [43]. 10. Int J Surg Pathol 20(1):5458, Ibrahim RE, Sciotto CG, Weidner N (1989) Pseudoangiomatous hyperplasia of mammary stroma. Br J Radiol 91(1092):20180213, Nakada H, Inoue M, Furuya K et al (2019) Fat necrosis after breast-conserving oncoplastic surgery. 8. T1-weighted post-contrast fat-saturated MRI of the chest (c) shows invasion of the pectoralis major muscle by this irregular enahancing mass (dotted arrow). The management of fat necrosis is based on the imaging features. Abscesses can be associated with lactation, in the case of puerperal abscesses, or independent of pregnancy, in the case of nonpuerperal abscesses [2]. Am Surg 76(3):292295, Berna-Serna JD, Madrigal M (2004) Percutaneous management of breast abscesses. Any non-adipose components must be carefully assessed to exclude a more aggressive component. Core needle biopsy of the mass showed stromal fibrosis without evidence of malignancy. When reporting lipomas on MRI, the article lipoma vs well-differentiated liposarcomacovers the differentiating factors well. Calcification may be present in up to 11% of cases, although more commonly associated with well-differentiated liposarcoma 5. Power Doppler ultrasound images (b, c) reveal two hypoechoic, oval masses with peripheral vascularity in the same region (asterisks). Multicentric and bilateral involvement is frequent. 7). She did not have a history of diabetes or other known immunologic condition. Cookies policy. What is a isoechoic | HealthTap Online Doctor Increased through-transmission deep to a nerve sheath tumor is common, arrows in A and between cursors and arrows, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window). Therefore, close clinical and imaging follow-up is indicated to ensure that there is no interval development of new breast masses [22]. Lipomas are benign tumors composed of mature adipocytes. ; vol. The patient underwent three core needle breast biopsies of the mass in the left breast over the span of a month, and a skin punch biopsy. Mediolateral oblique (a) mammogram shows a focal asymmetry in the upper outer breast (arrow) and associated trinagular palpable marker. Ann Surg Oncol 20(13):40964102, Kasper B, Baumgarten C, Garcia J, et al (2017) An update on the management of sporadic desmoid-type fibromatosis: a European Consensus Initiative between Sarcoma PAtients EuroNet (SPAEN) and European Organization for Research and Treatment of Cancer (EORTC)/Soft Tissue and Bone Sarcoma Group (STBSG). Fibrosarcoma is a malignant tumor of low-to-intermediate grade that is most common in the adult population aged 40 to 70 years. Malignant nodes often have a peripheral or mixed rather than hilar vascular pattern on color and power Doppler imaging. Acta Radiol 55(4):409415, Lee SJ, Mahoney MC, Khan S (2011) MRI features of stromal fibrosis of the breast with histopathologic correlation. Radiology. Skin thickening, distended lymphatic vessels, and inflammatory axillary adenopathy can also be seen. Quora - A place to share knowledge and better understand the world A 47-year-old woman presented with a palpable mass. Although tubular adenoma and fibroadenoma are both epithelial tumors, a tubular adenoma is histologically distinguished from a fibroadenoma by its tightly packed tubular or acinar epithelium and sparse connective tissue. Br J Radiol 87(1039):20140182, Yilmaz R, Bayramoglu Z, Kartal MG et al (2018) Stromal fibrosis: imaging features with diagnostic contribution of diffusion-weighted MRI. With regard to their . Breast J 18(3):242247, Yoon KH, Koo B, Lee KB et al (2020) Optimal treatment of pseudoangiomatous stromal hyperplasia of the breast. On MRI, PASH usually presents as a circumscribed mass resembling a fibroadenoma, but it can also present as non-mass enhancement in a focal or segmental distribution (Fig. Superficial lipomas are typically oval or oblong, well defined, compressible, and show no flow on color or power Doppler imaging. Fat necrosis comprises 2.75% of breast lesions and is incited by the destruction of adipocytes, which causes an inflammatory process [31]. Liver tumors | Radiology Reference Article | Radiopaedia.org Non-mass enhancement has also been reported [31]. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. J Clin Ultrasound 28(7):319324, CAS Spontaneous resolution has been reported in about half of patients [20]. Staging and histology help to determine whether and what type of surgery and adjuvant radiation or chemotherapy are employed. Contrast-enhanced ultrasound manifestations of renal masses Four phase, i.e., unenhanced, corticomedullary (20-40 seconds), nephrographic (80-90 seconds) and excretory phase (180-300 seconds) contrast-enhanced CT scan is recommended for detailed evaluation and characterization of renal masses. Granulomatous mastitis. liposarcoma,adrenal myelolipoma,angiomyolipoma, thorax, e.g. Ultrasound-guided biopsy yielded stromal fibrosis. Deeper or larger lesions may have scattered areas of internal soft-tissue density, often more apparent on CT versus MRI. At the time the article was last revised Ashesh Ishwarlal Ranchod had Needle biopsy showed acute inflammatory cells consistent with abscess without evidence of malignancy. Color and power Doppler may help distinguish between cystic and solid masses and characterize malignant masses and lymph nodes. To date, there is no evidence that lymphocytic mastopathy is associated with an increased risk of developing lymphoma [22, 25]. However, there are other imaging findings that can closely mimic malignancy: suspicious mammographic features of fat necrosis include irregular and spiculated masses, architectural distortion, asymmetries, coarse heterogeneous and even branching or pleomorphic calcifications. Soft-Tissue Lipomas: Accuracy of Sonography in Diagnosis with Pathologic Correlation. While a complete review of interventional techniques as they relate to soft tissue masses is beyond the scope of this chapter, several general points deserve emphasis. size, location, and ultrasound features of the scanned mass associated with clinical and other instrumental data can lead to correct diagnosis of the lesions. Superficial fibromatosis includes plantar and palmar fibromas. Asian J Surg 43(7):735741, Sengupta S, Pal S, Biswas BK, Phukan JP, Sinha A, Sinha R (2014) Preoperative diagnosis of tubular adenoma of breast10 years of experience. Google Scholar, Weinstein SP, Conant EF, Orel SG, Lawton TJ, Acs G (2001) Diabetic mastopathy in men: imaging findings in two patients. The most common sites of metastasis are the lymph nodes and lungs. MG, BA, and EA have contributed significantly to the writing of this manuscript. These conditions are usually distinguishable histologically. The first is the well-differentiated liposarcoma, the most common type of liposarcoma, most frequently located in the deep tissues when involving an extremity. Are Irregular Hypoechoic Breast Masses on Ultrasound Always Awareness of multiple malignancy mimickers, rare and common, is vital to clinical practice and plays a key role in radiologic-pathologic concordance, ensuring appropriate clinical management. With the advent of tomosynthesis, stromal fibrosis can present as architectural distortion. Sonograpically, sclerosing adenosis can present as a circumscribed mass, with variable echogenicity. Dr. David Sneid answered Endocrinology 43 years experience Probably benign: Depends on the appearance on ultrasound and also on lab and clinical parameters. 2. Provided by the Springer Nature SharedIt content-sharing initiative. Ultrasound Evaluation of the Ovaries Outline Normal and Inconsequential Findings, 920 Ovarian Cysts With Typical Benign Features, 920 Simple Cysts, 921 Hemorrhagic Cysts, 921 Endometriomas, 922 Mature Cystic Teratomas, 923 Ovarian Cysts With Typical Malignant Features, 924 Ovarian Cysts With Indeterminate Features, 925 Solid Ovarian Masses, 926 There is associated axillary adenopathy (solid arrow in e). Possible additional descriptors include the following: . A 65-year-old woman presented for further evaluation of a focal asymmetry detected on screening mammopgrahy. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Doctors can diagnose a mass on the kidney using. Diagnostic Histopathology of Tumors, 4th edition. Scrotal Ultrasound | Radiology Key Here are some. Mammographically, desmoid fibromatosis presents as an irregular, high-density mass with spiculated margins (Fig. Mammographically, tubular adenomas have been associated with tightly grouped microcalcifications, which can be suspicious in morphology and may warrant biopsy [61]. Granular cell tumor.
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