I. Paget’s disease (also known as eczema-like carcinoma)
The tumor grows in the direction of nipple and areola in the dominant duct, which is easy to diagnose clinically, and there is often no abnormal finding on X-ray.
Clinical manifestations: It occurs in middle-aged women, with itching and redness of nipple at the beginning of the disease, followed by eczema of nipple areola, nipple vesicles or fissures; the disease may form a large area of vesicles and thickened skin disease if the disease continues to develop, and the nipple may appear partially or completely as in severe cases.
Pathology: the presence of Paget cells within the epidermis of the nipple areola is the only basis for the diagnosis of the disease. The cells are characterized by large, rounded cells with transparent cytoplasm and small nuclei.
X-ray manifestations.
1. Nipple areola changes: due to the infiltration of cancer cells and lymphatic expansion, thickening of the nipple areola skin is formed;
2.Post-areolar duct phase enhancement and stiffness;
3.Intra-mammary masses, generally rare, or small if any;
4.Calcifications, which are easy to occur, are mostly seen as mucoid, in clusters or in patches. Calcifications within the nipple areola and along the large ductal distribution behind the areola are characteristic of this disease.
II. Inflammatory breast cancer
Also known as carcinomatous mastitis or tannic carcinoma
Clinical: It usually occurs in the larger overhanging breast, with rapid development and wide range of lesions. It is often accompanied by axillary lymph nodes and distant metastases. The main manifestations are redness, swelling, heat, pain and other inflammatory symptoms.
1, the most common mass without calcification, other features are: large tumor, clear boundary, located at the edge of the gland, or small lobulated, a few fuzzy margins, infiltration, high density.
2, calcification is rare
3.Limited dense shadow
Mucinous adenocarcinoma
It is common in postmenopausal women, with older age, slow growth and late metastasis.
Pathology: large tumor body, clear border, irregular morphology, jelly-like cut surface; microscopically, there is abundant mucus in the interstitium, cancer cells are separated into islands, small vacuoles in the cytoplasm, small and round nuclei, few divisions, deep staining, often on one side.
Medullary carcinoma
Preferably in young people, the tumor is large, often between 4-6 cm, mostly in the deep central part of the breast, spherical and nodular, with clear borders, soft texture, common bleeding and necrosis.
Pathology: the cancer cells are large in size, varying in shape, swollen in growth, rich in cytoplasm, large vacuolated nucleus, nuclear division is common, and lymph node metastasis is rare.
X ray manifestations.
1.Multiple round masses in deep part of breast without calcification;
2. The masses are lobulated with infiltrative margins;
3. The masses are of equal glandular density;
Special types of breast cancer
V. Lobular tumor
It is a bifurcated fibroepithelial tumor.
Clinical manifestations: It is rare, patients are in good general condition, mostly 40-59 years old, tumor growth is slow, disease duration is long, most of the unilateral breast is solitary, located in the outer upper quadrant, when palpation can be palpated the mass is huge round or lobulated, the surface is nodular soft and hard, the border is clear and active.
Pathology: The tumor is often lobulated, tough, with clear borders, complete envelope, grayish white or various colors, solid in small cases, cystic cavity in large cases, with brown fluid, blood clots or jelly-like material, often with hemorrhagic necrosis or mucus-like changes in the cancer foci.
Microscopic examination: it is composed of epithelial component and abundant mesenchymal cells; according to the amount of mesenchymal cells, cell anomalies and nuclear division phase, it is classified as benign, malignant and junctional.
X-ray performance: mainly depends on the size of tumor
1.Small tumors are mostly round nodules with smooth edges and uniform density;
2.Large tumors show lobulated shape with uneven density, but smooth edges; malignant signs such as burr are rarely seen;
3.Calcification is rare. About 8% of the tumors show coarse irregularity or lamellar calcification;
Generally speaking, masses larger than 8 cm in diameter are mostly malignant, with fast growth and short multiplication time, 36 days for malignant and 165-638 days for benign.
Malignant lymphoma
Malignant lymphoma is relatively rare, accounting for 0.12-0.53% of malignant tumors.
Clinical manifestations: The age distribution, symptoms and signs of malignant lymphoma of breast are similar to those of breast cancer, and the main complaint is breast lump. It has both primary and secondary forms.
X-Ray manifestation: Malignant lymphoma can be of two types, one is nodular type and the other is diffuse type
Nodular type presents as round or other types of masses with different degrees of burr or irregular margins, sometimes with clear margins and seemingly benign. There is little skin involvement.
Diffuse type: diffuse lesions, often involving more than a quarter of the breast, with unclear borders, mostly accompanied by diffuse edema and thickening of the skin. In malignant cases, there is often enlargement of axillary lymph nodes.