Copyright © 1997-2001 Mammography Specialists Medical Group Inc. All rights reserved

HISTORY:
31 year old with palpable nodule left upper outer quadrant. Positive family history, mother.

DIAGNOSIS:
Benign lactational change with ultrasound guided core biopsy.

FINDINGS:
Left breast ultrasound done over the upper breast shows a hypoechoic nodule present near the skin in the central portion of the image. The nodule has good acoustic enhancement. The interface between the nodule and surrounding normal parenchyma is circumscribed.


Image 1. Left breast US

The second ultrasound image of the nodule now shows a
bright tubular echo between it and the skin. This is
the core needle being positioned prior to firing.


Image 2. US with core needle positioned before firing

An US dynamic video segment shows this 14 gauge core biopsy needle passing through the nodule under US guidance.

Image 3. US dynamic video of needle biopsy (slow download)

An US image done minutes later shows a thin bright linear track within the nodule. This is from (bloody) fluid which rapidly fills in the thin cylindrical space left by the core biopsy needle pass.


Image 4. US just after core needle biopsies

DISCUSSION:
Five cores of firm white tissue were obtained at core biopsy. Sections show benign mammary tissue in which there was prominent lactational changes of the lobules. The change was uniform and appeared to be physiologic. The patient had been breast feeding for several months. During lactation the breast becomes fully differentiated. Histologic changes in the terminal ducts and lobules include enlargement and formation of new lobular units. The new lobules evolve to a point where they may occupy the majority of the breast parenchyma. As lactation subsides, these lobular units become more compact and lose the luminal secretions, and the interlobular stroma again become more prominent.

REFERENCE:
Powell, Deborah E., Stelling, Carol B. The Diagnosis And Detection Of Breast Disease. Function of the female breast. Mosby-Year Book, Inc., St. Louis. 1994; Chapter 1: p. 8.

Submitted by:
Ralph L. Smathers, M.D.
Mammography Specialists Medical Group
Los Gatos, California

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