Inflammatory and Reactive Tumors
SYED A. HODA
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Fat necrosis in the breast may result from trauma, but it is frequently a consequence of surgery or radiation therapy. Prior to breast-conserving therapy, no specific antecedent exogenous cause was reported in many instances. Trauma was described as the cause of fat necrosis in 32% of patients reported by Haagensen1 and in 44% of women reported by Adair and Munger.2 The observation that the clinical features of fat necrosis mimic carcinoma was first emphasized by Lee and Adair3 in 1920.
Traumatic fat necrosis occurs more frequently in overweight women and in women with pendulous breasts. Haagensen1 reported a mean age of 52 years with a range from 27 to 80 years. The youngest patient in the Adair and Munger series2 was 14 years old, with a median age in the 50s.
Patients typically present with a painless mass located superficially in the breast, accompanied by retraction or dimpling of the overlying skin if the lesion is superficially located. The skin may be thickened clinically and radiologically. Fat necrosis most frequently occurs in the subareolar and periareolar regions, but any part of the breast may be affected. Tumors formed by fat necrosis average 2 cm in diameter. They are firm and relatively circumscribed on palpation. The clinical problem of distinguishing between fat necrosis and recurrent or de novo carcinoma is especially difficult in patients who have undergone breast-conserving surgery and radiation therapy.4 Fat necrosis has been reported after various forms of radiation therapy, including external beam, iridium implantation, mammosite, and intraoperative radiation. Massive fat necrosis of the breast has been described as a complication of secondary hyperparathyroidism with mural arterial calcification.5
Mammographic findings were initially characterized by Leborgne.6 The manifestations of fat necrosis on mammography, ultrasound, and magnetic resonance imaging (MRI) depend upon its stage of evolution and can thus be highly variable.7 Mammography usually reveals a spiculated, often poorly defined mass that may contain punctate or large irregular calcifications.8 Less frequently, the lesion consists of a circumscribed, “oil-filled,” partly calcified cyst.6,9,10
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