Zuhal Bayramoglu1, Rejin Kebudi2,3, Ravza Yilmaz4, Sema Buyukkapu Bay3, Abut Kebudi5, Hasan Karanlik6, Ayca Iribas7, Emin Darendeliler7, Semen Onder8, Bilge Bilgic8, Ibrahim Adaletli1. 1. Pediatric Radiology Division, Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. 2. Pediatric Hematology-Oncology Section, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. 3. Pediatric Hematology-Oncology Department, Oncology Institute, Istanbul University, Istanbul, Turkey. 4. Radiology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey. 5. Department of Surgery and Surgical Oncology, School of Medicine, Maltepe University, Istanbul, Turkey. 6. Department of Surgery, Istanbul University Oncology Institute, Istanbul, Turkey. 7. Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey. 8. Pathology Department, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Abstract
BACKGROUND: Primary breast rhabdomyosarcoma (RMS) can occur in children. There is a lack of knowledge regarding radiologic findings and added diffusion-weighted magnetic resonance imaging (MRI) features of RMS in the literature. CASE REPORT: A 12-year-old girl was diagnosed with primary alveolar RMS of the breast. Gray scale ultrasound revealed posterior acoustic enhancement behind a well-circumscribed, multilobulated hypoechoic mass. Doppler ultrasound revealed increased peripheral and central vascularity. Hypointense septations on T2-weighted image exhibiting more enhancement than the stroma on late gadolinium-enhanced images were striking within a hyperintense mass. A hyperintense hemorrhagic focus on T1-weighted image was present in the absence of any necrosis. Avid enhancement on early postcontrast images proceeding from the periphery to the center was depicted. CONCLUSION: A rapidly enlarging mass with an echogenic peripheral rim together with posterior acoustic enhancement on gray scale ultrasound, intense vascularity on Doppler ultrasound, axillary lymphadenopathy, and satellite nodules on MRI should raise suspicion. Enhancing central and peripheral septations are suggestive of RMS. Dynamic contrast-enhanced MRI in suspected cases can provide valuable data in the differential diagnosis.
BACKGROUND: Primary breast rhabdomyosarcoma (RMS) can occur in children. There is a lack of knowledge regarding radiologic findings and added diffusion-weighted magnetic resonance imaging (MRI) features of RMS in the literature. CASE REPORT: A 12-year-old girl was diagnosed with primary alveolar RMS of the breast. Gray scale ultrasound revealed posterior acoustic enhancement behind a well-circumscribed, multilobulated hypoechoic mass. Doppler ultrasound revealed increased peripheral and central vascularity. Hypointense septations on T2-weighted image exhibiting more enhancement than the stroma on late gadolinium-enhanced images were striking within a hyperintense mass. A hyperintense hemorrhagic focus on T1-weighted image was present in the absence of any necrosis. Avid enhancement on early postcontrast images proceeding from the periphery to the center was depicted. CONCLUSION: A rapidly enlarging mass with an echogenic peripheral rim together with posterior acoustic enhancement on gray scale ultrasound, intense vascularity on Doppler ultrasound, axillary lymphadenopathy, and satellite nodules on MRI should raise suspicion. Enhancing central and peripheral septations are suggestive of RMS. Dynamic contrast-enhanced MRI in suspected cases can provide valuable data in the differential diagnosis.
Entities:
Keywords:
Breast; Magnetic resonance imaging; Pediatric; Primary rhabdomyosarcoma; Ultrasound imaging
Authors: D M Hays; S S Donaldson; H Shimada; W M Crist; W A Newton; R J Andrassy; E Wiener; J Green; T Triche; H M Maurer Journal: Med Pediatr Oncol Date: 1997-09
Authors: Ellen M Chung; Regino Cube; Gregory J Hall; Candela González; J Thomas Stocker; Leonard M Glassman Journal: Radiographics Date: 2009 May-Jun Impact factor: 5.333