PMC5733180_01
Clinical photograph of a 25-year-old woman presenting with symmetrical breast enlargement, thickened skin, and redness.
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Edema was also observed in both breasts (Figure 1).
Sonographic and mammographic findings. Ultrasound of the left and right breasts showing different heterogeneous, hypoechoic, well circumscribe oval masses. Note the heterogeneous echogenicity of the breast parenchyma (a-c). Sonogram of the left breast demonstrating a hypoechoic well-circumscribed oval mass measuring 80 mm (longitudinal axis), with low flow vascularity detected by Doppler imaging (d). Craniocaudal (CC) breast mammogram of the right breast with increase in density, which decreased the sensitivity of mammography (e).
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Then, a complementary ultrasound was performance, revealing heterogeneous breast echotexture with hypoechoic areas and multiple circumscribed solid masses in both breasts, ranging in diameter from 3 to 8 cm (Figures 2(a)-2(e)).
Magnetic resonance imaging findings. Right (a-b) and left (c-d) sagittal noncontrast fat suppressed T2-weighted image (T2W-FATSAT) showing extreme fibroglandular tissue and multifocal well-circumscribed masses, with internal linear reticular strands. Axial noncontrast fat suppressed T2-weighted image (T2W-FATSAT) (e) and axial contrast fat suppressed T1-weighted dynamic sequence after 6 minutes (T1WFATSAT+G) (f) demonstrating bilateral breast enlargement, with multiple circumscribed masses that present heterogeneous and persistent enhancement. Areas of nonmass enhancement with diffuse distribution also are observed in the inner and external quadrants of both breasts.
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A magnetic breast resonance was performed for surgical planning, confirming multiple bilateral circumscribed masses with avid and persistent enhancement after gadolinium administration, which is usually related to a benign etiology (Figures 3(a)-3(f)).
Photomicrograph shows high stromal cellularity of glandular tissue with intralobular and perilobular involvement. Slit-like spaces lined by myofibroblast (hematoxylin and eosin stain, original magnification x10) are demonstrated (a-b), which were positive for CD34 (c) and calponin (d).
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Those cells exhibited strong positivity for CD34, actin, and calponin (Figures 4(a)-4(d)) and negativity for estrogen and progesterone receptors.