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Teaching atlas of mammography pdf

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Teaching atlas of Mammography. Stuttgart. Thieme Verlag Svane G, Potchen EJ, Sierra A, Azavedo E. Stellate lesions. In: Patterson A. ed. Screening . Request PDF on ResearchGate | On Feb 1, , L Tabár and others published Teaching Atlas of Mammography. Teaching atlas of mammography. Laszlo Tabar, Peter B. Dean. × mm. Pp. + viii. Illustrated. Stuttgart: Georg Thieme Verlag. DM


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Teaching Atlas of Mammography, 4th Edition () - Ebook download as PDF File .pdf), Text File .txt) or read book online. Teaching Atlas of Mammography. Editorial Reviews. From the Back Cover. The names Tabar and Dean are associated with In this fourth edition of the bestselling Teaching Atlas of Mammography, readers are again invited to share in the authors experience of analyzing and. The names Tabar and Dean are associated with high-quality mammography worldwide. In this fourth edition of the bestselling Teaching Atlas of Mammography.

Each is associated with its own characteristic surrounding radiating struc- ture. We have revised this As breast-imaging methodology improves by quantum leaps. Practice in Calcification Analysis A year-old asymptomatic woman. Whereas carcinoma. Enlarged view of the portion of the left breast containing the palpable tumor. Cases 58—85 Mammography Fig. A Fig.

Forgot password? Review as guest. Teaching Atlas of Mammography. Add to cart. Add to Favorite. Tabar Dean Tot. Publication Date:. Look Inside. Table of Contents.

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Product Description. Special features: Revised and expanded case studies, based on 40 years of imaging experience, provide instructive long-term follow-up of patients over a period of up to 25 years Offers a unique comparison of imaging findings with the corresponding large thin-section and subgross thicksection 3D histologic images to facilitate an understanding of the pathologic processes and the mammographic appearances they lead to Includes an abundance of coned-down compression views, microfocus magnification views, and specimen radiographs to support the analytic workup Teaching Atlas of Mammography and the Breast Cancer book series by the same authors are essential for residents in radiology and practicing radiologists who need the highest level of training in the radiologic anatomy of the normal breast and the changes associated with benign and malignant lesions.

Radiology , Breast Imaging. Rate this product. Get NEWS! Product Search. Junge Jupiter Jutta Hochschild K? Masking excludes the shaded re- gion from view. Masking is equally necessary for viewing film or digital formats. XVI aspects The goal of perception is to: Digital software can perform this func- tion when viewing soft copy images on dig- ital monitors.

XIII Horizontal masking. A hand-held viewer is an excellent tool for viewing films Fig. Perception of subtle altera- tions can be accentuated by using masking techniques to enable sequential viewing of restricted areas of the mammograms. XIII and cranial Fig. Stepwise horizontal masking with the edge of the viewer when reading film images. XV and caudal Fig. Method for Systematic Viewing of Mammograms 7 Fig. Stepwise horizontal masking facilitates the comparison of corresponding regions of the two breasts.

XIVb Horizontal masking. XIVa Horizontal masking. XVb Fig. XVa Fig.

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Oblique masking from the as shown. The masks are initially placed along cranial aspect is also very helpful in Cases XVb Case Right and left breasts of the mammograms. This is demonstrated in MLO or lateromedial projections are viewed Fig.

XVa Oblique masking. XVIb Fig. The two masks are rotated outwards in a stepwise fashion. XVIa Oblique masking. XVIa Fig. Method for Systematic Viewing of Mammograms 9 Fig. Asymmetries within the parenchyma. XVIIa Fig. Perception of such subtle changes re- quires careful. XVIIa Diagrammatic illustration of paren- chymal distortion. A radiating structure is outlined in the right breast. XVIIb Right and left mammograms. MLO projections. Method for Systematic Viewing of Mammograms 11 Fig.

See also Case While the posterior border is normally smooth and usually con- cave. XVIIIb Mammographic illustration of parenchymal contour retraction arrow caused by a renchymal contour retraction in the cranio.

No tumor is visible. XVIIIe year-old woman. CC pro- jections on Fig. CC projection. Method for Systematic Viewing of Mammograms 13 Fig. Diagrammatic illustration of retraction of the parenchymal contour on the mediolateral oblique projection.

XIXb Mammographic demonstration of focal protrusion of the parenchymal contour arrow. XIXa Detection of parenchymal contour retraction may lead to the diagnosis of small tumors in dense breasts in which the tumor itself may be hidden. Compare this contour with the corres- ponding region of the contralateral breast. Poor-quality images or im. Thickened skin syndrome: The systematic viewing should breast. Any combination of two or more of the searching after you have found the first above findings.

Calcifications that may or may not be errors associated with a tumor. Do not stop V. These malignant lesions may lead to when surrounded by radiolucent adipose difficulties in diagnosis. Density should be evaluated in rela. Since such lesions are always been determined.

These are denser than the surrounding pa- mographically demonstrable capsule is renchyma. The two anal. The following four steps of analysis can rapidly lead to mammographic diagnosis: The surrounding parenchymal structures as in a lipoma or fibroadenolipoma.

Teaching Atlas of Mammography, 4th Edition (2011)

Structures such as veins. All radiolucent. Its orientation is random. A solid tumor e. The di. Its orientation. Mammographic workup: If either mammography Satisfactory or needle biopsy Cyst puncture under microscopic is suspicious for ultrasound guidance diagnosis: Solid Intracystic Simple Needle biopsy lesion tumor cyst Microscopic diagnosis can be obtained using needle biopsy.

Ultrasound opsy. The combined use for Routine rescreen benign of mammography. Yes After the four steps of analysis contour. Wart fibroadenolipomas. Analysis Form: Right breast. There are central calcifications. A huge. Physical Examination A huge. Mammography Fig. There is a solitary lesion 5 cm from the nipple in the upper medial quadrant. There are no asso- ciated calcifications. Physical Examination No palpable tumor.

MLO projection. A scar is seen between the lesion and the skin Fig. An oval-shaped. Detailed view of the MLO projection of the left breast. There is a central. In this case. No further procedures are necessary. Note There are many ring-like calcifications near the oil cyst.

These represent liponecrosis microcystica calcificans. With a partially calcified capsule. There is no need for ultrasound or needle biopsy. A large tumor fills in the central portion of the breast Fig. There is a large.

The history and mammographic appearance are consistent with a galacto- cele. The small size helps to differentiate it from a fibroadenolipoma that is typically large.

The absence of trauma or previous breast surgery helps to exclude a hematoma or oil cyst. Left breast. A lesion with mixed density is seen arrow. Detailed view of the retroareolar region. Comment The history points to a galactocele.

Magnification view. A tu- mor is seen 7 cm from the nipple. Needle puncture. Breast ultra- sound will not add any further information. Physical Examination A very soft. This lesion is an intramammary lymph node with a typical central radiolu- cency corresponding to the hilus. Further differentiation can be made as follows: A soli- tary lesion is seen in the upper outer quad- rant. A photographic magnification of the lesion.

Magnification view of the lesion. The central radiolucent area corre- sponds to the hilus. A small circular lesion is seen in the upper outer quadrant without associated calcifica- tions.

Intramammary lymph nodes can be found in any quadrant of the breast. Magnified view of the lesion. An oval-shaped lesion with no associated calci- fications is seen 4 cm from the nipple. No associated calci. Magnified view of the tumor. MLO and CC pro.

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Conclusion trauma to her right breast 2 weeks earlier. Superficial solitary tumor in the best seen on the magnified view arrow lower lateral quadrant. This will noted a lump at the site of trauma. This year-old woman experienced Fig.

Both the history and mammographic ap- In addition to a superficial hematoma. Histology Fig. Clin- ically benign. MLO and CC pro- jections. Microscopic confirmation is neces- sary. A smaller circular lesion is seen in the upper outer quadrant 6 cm from the nipple. When present. The smaller lesion. Physical Examination 3 cm. Breast ultrasound may demons- trate a cyst or a solid lesion. Inverted nipple. She was called back for further assessment of the finding in the right breast. Conclusion This is a mammographically benign tumor.

There is an oval-shaped. If solid. Analysis Fig. Physical Examination 2 cm tumor in the upper inner quadrant of the right breast. There is a tumor with no associated calcifi- cations 6 cm from the nipple in the upper half of the breast. Micro- scopic diagnosis is necessary to differentiate between an ill-defined fibroadenoma and a low-density malignant tumor. She was called back for further examination of the solitary. Histology Fibroadenoma.

Core needle biopsy would have Fig. CC and MLO pro- jections. Fine Needle Aspiration Biopsy Cells suspicious for malignancy. No as- sociated calcifications. No skin changes. A partially calcified artery is seen superim- posed over the lesion in Fig. Physical Examination Approximately 2 cm freely movable tumor in the lower outer quadrant of the right breast.

Spot magnification view in the CC projection. A solitary tumor without asso- ciated calcifications is seen in the upper outer quadrant of the breast. The air insufflation may also be used to prevent cyst recurrence. Comment The halo sign may be extensive in cysts. There is a solitary retroareolar tumor with no associated calcifications.

She was aware of a lump in her left breast but did not seek medical advice. The availability of breast ultrasound provides Fig. Physical Examination Tender.

Before the development of breast ultrasound. Simple cyst. There is a solitary. Specimen radiograph of the ex- cised tumor Fig. Low-power large-section histol- ogy: A sliced specimen radiograph Fig.

Ultrasound images demonstrate an intracystic papillary lesion. This proved to be a lipoma. Specimen Radiographs Fig. At mammography examination. Detailed histology images: When sharply outlined. Breast Ultrasound Fig. MLO and CC projections. The benign options include a small papil- loma or a cyst. No evidence of malignancy. A small solitary tumor with no associated calcifications is seen in the upper outer quadrant. Small lesions surrounded by a considerable amount of adipose tissue may be difficult to convincingly demons- trate with breast ultrasound.

Microfocus magnification views. Fine Needle Aspiration Cyst fluid with macrophages. Stereotactic guidance will then be necessary for micro- scopic diagnosis. Physical Examination Freely movable. Solitary tumor with no associated calcifications. Ultrasound-guided intervention or pneumocystography will lead to the final diagnosis.

Strategy Ultrasound is the first ancillary method of choice to narrow down the differential di- agnosis. Clinical and mammo- graphic examination have a wide range of differential diagnostic options. Histology Giant fibroadenoma. In a patient this young. Physical Examination Huge. The large lesion size and the risk for inflammation prompted surgical removal.

This is the first screen- ing examination. A solitary tumor is located in the upper outer quadrant. There are no associated calcifica- tions. Numerous microcalcifications are seen in the tumor. A soli- tary tumor is located in the lower half of the breast. High-power view of the lesion's periphery. Histology Cavernous hemangioma. Low-power photomicrograph of the lesion showing the typical structure of a cavernous hemangioma.

Analysis of the Tumor Form: The air out- lining the fine. Comment Well-trained technologists are familiar with the appearance of typical skin lesions and Fig. Two cases of warts. Most warts have a typical mammographic ap- pearance. The borders are sharply outlined with a multilobulated contour. A large tumor associated with coarse calcifications is seen in the upper outer quadrant.

Physical Examination A freely movable tumor. In this case the calcifications indicate the diagnosis of a phyllodes tumor. Histology Benign phyllodes tumor cystosarcoma phyllodes. Typical leaf-like phyllodes projec- tion of a duct-like structure into the lumen. There is no skin retraction.

Comment Huge. MLO and CC projec- tions. Galactography may assist in the diagnosis. Analysis Location: Blood was expressed from the nipple during the mammographic examination.

Galactography CC projection. There are several retroareolar tumors. Seven months later the patient felt a lump in the lower half of the right breast. Mucinous and pap- illary carcinomas may have a low density at mammography. This sus- picion is strengthened by the fact that the tumor has developed within a short time in an year-old woman. The mammogram was interpreted as normal. Repeat Mammography Fig. Microfocus magnification view in the MLO projection. The tumor arrows has no associated calcifications.

No lymph node meta- stases. There are no associated calcifications. No lymph node metastases. CC view. Follow-up The woman died 5 years 10 months later from cerebral infarction at the age of 86 years. There was no evidence of breast can- cer at the time of death. Physical Examination The palpable tumor in the right breast is clinically malignant.

Histology Well-differentiated ductal carcinoma. Specimen radio- graph. Microfocus magnification mammography in the CC and LM laterome- dial projections. This can be obtained using ultrasound- guided core needle biopsy. No associated calcifica- tions. An oval-shaped lesion is located in the medial half of the breast. No further diagnostic proce- dures are necessary. There is a solitary tumor in the upper outer quadrant. There are no associ- ated calcifications. The presence of an air pocket best seen on the MLO projection suggests that the lesion protrudes from the skin surface Size: Clinical examination reveals a typical seba- ceous cyst.

A ductal carcinoma of this size would have a much higher density. Follow-up The woman was still alive 20 years later Fig. High-power magnification of the mucinous carcinoma near the tumor border. The combination of older age. Histology Mucinous carcinoma without axillary lymph node metastases.

There was no evidence of breast cancer at the time of death. Lateromedial view with biopsy lo- calization plate. A solitary tumor is seen in the upper outer quadrant. No axillary lymph node metasta- ses. The hook localizes the tumor for biopsy. Follow-up The woman died 16 years later from cardio- vascular disease. These signs are characteristic of a mammo- graphically malignant tumor. Conclusion Fig. The high-density lesion has ill- defined borders. Ultrasonography confirms the mammographic findings.

Cytology Malignant cells. Microfocus magnification in the CC projection. Physical Examination A solitary. Follow-up The woman died 7 years and 8 months later from myocardial infarction.

No mammographic abnormality is seen. Second screening examination at the age of 60 years. The benign differential diagnostic option is a papilloma. A tumor is seen high up in the axillary portion of the breast. Histology Lymphoma in both the breast and the iliac fossa. It is a mammographically malignant tumor. Nor- mal mammogram. Two years later the patient presented with a 2-month history of a mass in the axillary portion of the right breast and a mass in the right iliac fossa.

No associated calcifications were demonstrable. Follow-up The woman was still alive 18 years later at the age of 84 years. Physical Examination Benign tumor. Histology Benign phyllodes tumor. Ultrasound can easily differentiate between the two. Solid tumors should be subjected to microscopic diagnosis.

Detail of Fig. Low-power view showing the leaf. Physical Examination Inspection: Follow-up The patient was placed on oral antibiotics. Comment An inflammatory carcinoma and a huge re- troareolar abscess could both produce this clinical picture.

En- larged axillary lymph nodes. Ultrasound is not the primary diagnostic procedure of choice since necrosis. Mammography of the left breast after puncture and air insufflation: Ultrasound- guided needle puncture can establish the correct diagnosis.

It is associated with nipple retraction and skin thickening over the areola and lower portions of the breast. Left breast heavier than right. MLO and CC projection.

Repeat mammography in the MLO projec- tion Fig. Puncture 60 mL of pus was aspirated. The patient is febrile. Cytology Inflammatory cells. Cystic degeneration of a medullary cancer with a thin rim of viable tumor tis- sue. There is an oval-shaped tumor in the upper inner quadrant with no associ- ated calcifications. Physical Examination 2 cm freely movable tumor in the upper inner quadrant of the right breast.

The infe- rior and anterior wall of the cyst is sharp. Needle biopsy is recom- mended. Ab- scess? Inflamed cyst? There is a tripolar mitosis arrow. The very high proliferation rate of the tumor cells is demonstrated by immu- nohistochemical staining for Ki antigen.

No malignant cells. Tumor in the cyst wall? Histology Medullary cancer in a 2-cm segment of the wall of a cyst. Typical histologic picture of a me- dullary carcinoma with poorly differenti- ated cancer cells and intense lymphoplas- Fig. Follow-up The patient died 16 years 5 months later of metastatic breast carcinoma at the age of 52 years. Histology Multiple malignant melanoma metastases.

Analysis of the Larger Tumor Form: Physical Examination There is a hard. MLO projection shows two oval-shaped tumors near the chest wall. There is a solitary tumor 4 cm from the nipple. Histology Partly ductal. Photographic enlargement of the spot compression view of the tumor. The pectoral muscle ap- pears to be infiltrated. There is a patholog- ically enlarged lymph node in the axilla. Failure to drain pus with a large-bore needle should heighten the suspicion of malignancy.

How- ever. A large. The ancillary method of choice is ultra- sound-guided needle aspiration. MLO and CC projec- tions after puncture. Conclusion Abscess with a thick irregular wall. Histology Abscess. Magnification Immersion Radiography of the Left Hand Radiographic changes in the soft tissues and bone. Nor- mal breast. Enlarged axillary lymph nodes bilaterally. Comment When the axillary lymph nodes are en- larged and breast disease can be ruled out with certainty by physical examination.

She was called back for further examination of the finding in the axillary regions of the mammograms. Physical Examination No abnormalities in the breasts. Histology Mucinous carcinoma. Physical Examination Freely movable tumor below the nipple. The low-density radiopaque appearance on the mammogram can be explained by the high mucinous content. No axillary lymph Fig. Mucinous car- cinoma is also difficult to detect with ultra- sound.

Mammographic picture of pa- thologically enlarged axillary lymph nodes in a year-old woman with chronic lym- phatic leukemia. Two weeks later. Comment As this case demonstrates. For this rea- son. A solitary tumor is seen 6 cm from the nipple. The resolving hematoma still ob- scures the tumor. Histology Benign intraductal papilloma. Fine Needle Biopsy Fig. Cytology Fig.

Mammogram following fine nee- dle aspiration biopsy shows the typical ap- pearance of a hematoma. Microfocus magnification view. Further differential diagnosis follows that Fig. The radiolucent part corresponds to the hi- lus of this intramammary lymph node.

A solitary lesion is seen in the upper half of the breast. No further procedures are indicated. Analysis of the Lesion Fig.

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A cm long. Analysis of the Calcifications Location: There are associated calcifications. No evidence of ma- lignancy. Physical Examination An elongated. Solitary tumor. Cytology Benign epithelial cells. Spot compression microfocus magnification view of the tumor. CC projec- tion. A soli- tary tumor is seen in the central portion of the breast with no associated calcifications.

Spot-microfocus magnification images in the MLO Fig. The circular. Mammography and Ultrasound Fig. Details of the MLO Fig. The hand-held ultrasound im- ages demonstrate both an intracystic tumor the cystic component shows through transmission and. The intracystic growth is an 11 mm grade 1 in situ papillary carcinoma. Large format thin-section low- Fig. The thin. Comment The diagnostic workup of intracystic breast Fig.

Large-format thin-section low- power magnification showing both the in- tracystic papillary cancer and the adjacent invasive ductal carcinoma. Imaging can demonstrate the presence of an intracystic growth. Large-format thin-section inter- mediate-power magnification histology im- ages demonstrating the invasive ductal car- cinoma Fig. Cases such as this one with an adjoining comet-tail sign are more likely to be malignant.

Alpha-smooth-muscle actin stain demonstrating the lack of myoepithe- lial cells within the papillary structures. Ultrasound-guided fine needle aspiration biopsy: Ultrasound image of the solitary. Fine Needle Aspiration Biopsy Fig. No associated calcifications are demonstrable.

A solitary. The rarely seen liposarcoma is radiopaque sound Fig. The excised tumor and fat cells of varying sizes. Comment Fig. Preoperative hand-held ultra. Ultra- sound examination with ultrasound-guided needle biopsy provides excellent differen- tial diagnosis.

There is a tumor in the medial half of the breast. Detailed mammogram in the CC projection. Follow-up The patient died 2 years and 8 months later of metastatic breast carcinoma. The tumor is ER and PR positive.

Ultrasound examination reveals a cystic tumor with intracystic growth. Large-section histology images of the cyst containing several intracystic tumors. A large solitary. This mammographic situ or invasive carcinoma. The Malignant-type calcifications are com.

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Radial scars vary in ap- This is the typical picture of inva. These are the graphic images that are diagnostic: The most typical mammographic appearance of breast carci- noma is a stellate lesion. Each view may thus the spicules.

Skin changes may also with periductal elastosis. Spot compression microfocus magni- fication views are of great value in evaluat- ing these mammographic signs. Architectural distor- tion without a central tumor mass is a less common sign of malignancy. A ra-. Its perception requires familiarity with the full variety of normal breast parenchymal structure and an understanding of how pathologic pro- cesses produce distortion.

Perception of these lesions may be difficult. Although mammographic differentiation of breast carcinoma from other stellate lesions may be highly accurate. Each is associated with its own characteristic surrounding radiating struc- ture.

XXI Diagrammatic illustration of invasive ductal carcinoma: A collagen. Analysis of the central portion may show Fig. They occasionally contain in picture. Architectural dis- tortion without a central tumor mass may be caused by a number of malignant or be- nign diseases. This may Fig. Higher-reso- lution magnification mammography im- ages may reveal a small central tumor mass not seen in the initial mammo- graphic images. Comment The mammographic appearance of the small. Architectural distortion without a central tumor mass may also be caused by the fol- lowing diseases: Ultrasound examination assists in the differential diagnosis because the center of a radial scar shows cystic dilatation of the proliferating ducts.

Certain subtypes of breast cancer are characterized by for- mation of new. The mammo-. XXII Illustration of the mammographic appearance of a radial scar. Due to the absence of E-cadherin.

Complete surgical these lesions are associated with cancer in — localized skin thickening and retraction removal and thorough histological exami- situ or tubular carcinoma. Relevant patient history tectural distortion on the mammogram re- tions in these cases are the so-called contributes to the diagnosis. Mammography to small oil cysts are seen in the central will greatly facilitate the treatment plan- screening has brought attention to this portion.

Calcification type calcifications Case A prevalence of 0. The combination of patient history. Chapter VI. The occurrence of this cancer-imi. Fat necrosis fol. The older the lesion. When may be associated with either of these Although the definitive diagnosis of archi- present. The presence quires histologic examination. The characteristic ative differentiation between malignant mented.

The larger the tumor mass. When they extend to the skin or areolar region they cause retraction and local thickening. The presence of a central tumor mass with associated spicules is typical of malignant stellate tumors. It is recommended that radiologists refer to this case while analyzing other stel- late lesions.

The spicules are dense and sharp. No axillary metastases. Overview of the tumor with stain- ing for elastic fibers Mammogram Physical Examination No palpable tumor. MLO projec- tion. Histology Infiltrating ductal carcinoma. Cases 58—85 Mammography Fig. First screening study. A small tumor shadow is seen at coordinate A1. Follow-up The woman died 1 year and 11 months later from pulmonary embolism.

Specimen photograph. The tumor is seen at coordinate A1. Magnification view in the MLO projection. First screening examination. Follow-up The woman died 8 years and 5 months later from colon cancer.

A stellate tumor is seen in the upper inner quadrant. At the time of death. Maximum dia- meter 7 mm. Conclusion This tumor has the typical mammographic appearance of a malignant stellate breast tumor: Centrally located, large 5 cm dia- meter stellate tumor.

The nipple and areola are retracted. The skin is thickened and re- tracted over the lower and outer portions of the breast. Comment This is an illustrative example of an ad- vanced stellate malignant breast tumor with a large central tumor mass and radiat- ing spicules that retract the areola and skin. The tumor in- filtrates the lymph vessels. Right breast, CC projection. Right a and left b breasts, Fig. Right breast, microfocus magnifi- MLO projections.

Compare the lower halves cation view, MLO projection. Compare of the right and left breasts. In the lower half Fig. Observe how the of the right breast there is architectural dis- lesion has a different appearance in each A year-old asymptomatic woman. First tortion centered at coordinate A1. Conclusion This mammographic appearance is typical Fig. The diagnosis is supported by the lack of palpatory findings. No further diagnostic procedures are indicated. In fact, needle biopsy is contraindicated see p.

The next step should be open surgi- cal biopsy followed by careful histologic ex- amination. A large area with architectural distortion is seen 4 cm from the nipple. The mammographic appearance of the lesion changes with the projection. The two hollow, benign-type calcifications are not associated with the lesion.

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Analysis An invasive ductal carcinoma of this size would have a large, solid central tumor mass. Instead, there are central radiolucen- Fig. The radiating structure consists of long, thick, drooping linear densities inter- vening with radiolucencies. The mammo- graphic image is unlike the straight specu- lations of an invasive breast cancer. Unlike large breast cancers, this lesion was not pal- pable, nor was there skin thickening or re- traction. Conclusion Typical mammographic and clinical picture of a radial scar.

Complete surgical removal is recommended without preoperative needle biopsy see p. Operative specimen photograph. Comment An invasive ductal carcinoma similar in size to Cases 61—64 would be palpable and would have a large, dense, homogeneous central tumor mass dominating the picture compare Case 60 with Cases 61— Left breast, detailed view of the MLO projection. There is a large radiating structure in the upper half of the breast.

Analysis Best from the Microfocus Magnifi- cation Views No solid tumor center is demonstrable in this radiating structure. The radiating struc- ture consists of thick collections of linear Fig. Alternating with them are radiolucent linear structures parallel to these strands. Comment Even with such a large, superficial lesion, no tumor could be palpated.

This supports the diagnosis of a radial scar. Right breast, MLO projection. A Fig. The radiating structure is seen at coordinate A1. Right breast, enlarged view of the lateromedial LM projection. Analysis No solid tumor center. The appearance of the lesion changes remarkably with the pro- jection.

The radiating structure consists of thick linear radiopaque densities alternat- ing with linear translucencies. Complete surgical removal is the treatment of choice. Overview of the tumor.