【翻译】Sonographic Findings of PalpableIsoechoic Breast Fat Necrosis:可触及的等回声乳腺脂肪坏死的声像图表现

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医疗行业从业者 · 最后编辑于 2022-10-09 · IP 广东广东

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Sonographic Findings of Palpable Isoechoic Breast Fat Necrosis
可触及的等回声乳腺脂肪坏死的声像图表现


A 47-year-old woman had a new mass in the right breast. She had no notable medical history. Her last screening mammography 8 months beforehand was unremarkable. On physical examination she had a tender, smooth nodule in the right lower outer quadrant measuring 1 cm in diameter. Breast sonography was performed on an HDI 5000 system (Philips Medical Systems, Bothell, WA) with a broadband 5- to 12-MHz linear array transducer. Sonography revealed an isoechoic mass that was almost indiscernible along with neighboring breast tissue (Figure 1A). There was no posterior acoustic shadowing. Doppler sonography did not show vascularity in the lesion. The extension of this mass to the hypodermis (Figure 1A) was very helpful for lesion detection. Subsequent mammography with a lead marker signifying the location of the palpable mass showed a circumscribed area of lucency with a thin capsule (Figure 1B), a finding compatible with a lipid cyst. Such a pathognomonic mammographic appearance does not require any additional workup, and routine follow-up was recommended.
47岁女性右乳一个新生肿块，没有明确病史。在引引起注意的超声检查是8个月以前。体查右下1/4象限一结节，柔软、光滑，直径1cm。乳腺超声为HDI 5000 system (Philips Medical Systems, Bothell, WA) 5-12MHz线阵式换能器超声提示为一等回声的团块，与周围组织分辨不清（图A）。没有后方声影，多普勒超声没有发现病变内有血管。肿块延伸到皮下（图1）对病变的探测非常有帮助。后来的铅标记乳房造影表明了可触及的病变位置局限，有分隔的透亮区，与含脂囊肿相一致。如此一个特征性的乳房摄影表现并不需要任何附加工作。建议要常规随访。

Discussion

Fat necrosis of the breast is a benign process that may be mistaken for cancer on clinical examination or imaging studies. Pathologically, fat necrosis is a sterile, inflammatory process that varies in appearance depending on the stage of the lesion. Initially, there is a disruption of fat cells and hemorrhage. This is accompanied by an inflammatory cell infiltrate. During the subsequent reparative phase, fibroblasts proliferate at the periphery of the lesion, and eventually fibrosis may replace the areas of necrotic fat.1
讨论
乳房纤维坏死是一个良性过程，在临床检查或影像研究有时会误认为癌症。病理上，脂肪坏死是一个无菌的炎性过程，随炎性过程不同外观有所改变。最初脂肪细胞分裂、出血伴有炎细胞浸润。在随后的修复期，成纤维细胞在病变周围增生，最终纤维化取代坏死组织。1
The imaging features of fat necrosis of the breast reveal the histologic event at the time of the imaging study. Mammographic findings depend on the degree of fibrosis. Early, less extensive fibrosis is associated with a lipid cyst with a thin, fibrous capsule. With more extensive fibrosis, a spiculated mass may develop. An oil cyst is a distinctive form of fat necrosis with a usually pathognomonic mammographic appearance.2 This appears as an entirely radiolucent mass, representing macroscopic necrotic fat, surrounded by a thin fibrous membrane. However, a small oil cyst may not be recognized on standard mammographic views because it may be difficult to discern from a normal fat lobule surrounded by Cooper ligaments.

乳腺脂肪坏死的影像特点显示了在影像研究时的组织学活动。乳腺摄影结论取决于纤维化程度。早期，局限的纤维化伴有薄壁含脂囊肿。随着更广泛的纤维化，或许会发展成一个有毛刺肿块。在常规乳腺摄影上含脂囊肿是脂肪坏死一个特征性表现。2表现为可穿透的，肉眼可见的坏死脂肪，周围有纤维包膜。然而小的含脂囊肿由于难以和Cooper韧带包围的脂小叶鉴别在标准摄片也许不能被认出。
The sonographic spectrum of fat necrosis includes solid masses, complex cystic masses, and anechoic masses.1–4 Some palpable cases of fat necrosis may not be seen on sonography.3,4 Contemporary sonographic equipment has been shown to be very accurate in the evaluation of skin morphologic characteristics5 without the use of a standoff pad. We were able to recognize the isoechoic lesion in the breast because of the change in the sonographic appearance of the epidermis. According to our literature search, the isoechoic manifestation of fat necrosis has not been reported previously.
脂肪坏死的声像图包括实性的肿块，混合的囊性肿块，和无回声包块。1-4有些可触及的包块在超声上也许看不到。3.4同时没有使用托角垫的超声设备被认为在皮肤形态学特征评价实非常准确的。5由于表皮的声像图表现的改变我们能够辨认出等回声病变。根据我们查阅文献，等回声表明脂肪坏死以前未被报道。
Isoechoic lesions are very difficult to detect on sonography.6 Our case underscores the importance of meticulous sonographic technique in the evaluation of palpable mass. Sonographic detection of breast lesions allows guidance for taking tissue samples in the cases of mammographic or clinical concern. This may reduce the number of more expensive tests, such as magnetic resonance imaging and surgical biopsy, that are sometime performed for sonographically occult palpable breast lesions. In conclusion, we report a case of an isoechoic appearance of breast fat necrosis and underscore the importance of watching for skin contiguity as a possible sonographic change in palpable breast masses.

等病变在超声非常难发现。我们的病例强调了精准超声技术在评价乳房可触及包块的重要性。当乳腺摄影或临床可疑的情况下可行超声介导下取组织标本，避免了更昂贵的检查如MRI及外科手术活检。结论，我们报道了一例乳腺脂肪坏死表现并强调当可触及乳腺包块有一个可能的声像图改变时注意皮肤接触的重要性。

Figure 1. A, Right breast sonogram showing a mass that is almost indiscernible along with neighboring breast tissue. The lack of integrity of the hyperechoic superficial fascia (thin arrows) helps in recognition of the isoechoic breast mass (wide arrow). B, Right craniocaudal mammogram with a lead marker signifying the location of the palpable mass showing a typical oil cyst with radiolucent content and a thin fibrous membrane (arrow).
图1.A右乳腺显示一个几乎难以与临近乳腺组织辨认的包块，皮下组织缺少完整性的高回声（细箭）有助于与等回声的乳腺团块（粗箭）识别.B，右侧的头尾向有铅标记包块的位置的乳腺摄片显示一个典型的可穿透内容的含脂囊肿，有一个薄层纤维膜（箭）。