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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 14  |  Issue : 2  |  Page : 103-105

Benign fibrous histiocytoma of male breast: Ultrasonography, doppler, and elastography imaging with pathological correlation


Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission19-Jun-2018
Date of Decision05-Dec-2018
Date of Acceptance13-Aug-2019
Date of Web Publication25-Nov-2019

Correspondence Address:
Dr. Kaustubh Anil Madurwar
Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_44_18

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  Abstract 


Benign fibrous histiocytoma is a benign soft tissue tumor that can occur anywhere in the body, commonly in the dermis and rarely in the deep soft tissues and parenchyma organs. High-frequency ultrasound and Doppler ultrasound can help us characterize the tumors. Sonoelastography is a new improvement of ultrasound technique which is used to characterize soft tissue masses of the breast, thyroid, and lymph nodes, which can be used to identify the nature of pathology. Here, we report a case of benign fibrous histiocytoma in male breast, and ultrasound, Doppler, and sonoelastography features are discussed.

Keywords: Benign fibrous histiocytoma, breast lump, sonoelastography, ultrasonography


How to cite this article:
Madurwar KA, Phatak SV. Benign fibrous histiocytoma of male breast: Ultrasonography, doppler, and elastography imaging with pathological correlation. J Datta Meghe Inst Med Sci Univ 2019;14:103-5

How to cite this URL:
Madurwar KA, Phatak SV. Benign fibrous histiocytoma of male breast: Ultrasonography, doppler, and elastography imaging with pathological correlation. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2019 Dec 11];14:103-5. Available from: http://www.journaldmims.com/text.asp?2019/14/2/103/271551




  Introduction Top


Benign fibrous histiocytoma, also called as dermatofibroma, subepidermic nodular fibrosis, and histocytoma cutis, is a benign stromal neoplasm involving fibroblasts and histiocytes. The tumor occurs most commonly in the dermis; occurrence of these lesions in deep tissue of breast parenchyma is very rarely reported. This can occur in any age group with male predominance (2.5:1).[1] The neoplasm should be differentiated from malignant fibrous histiocytoma as it has aggressive course.


  Case Report Top


A 53-year-old male patient presented in our hospital with a lump in the left breast for 2 years. The clinical examination revealed a lump measuring 3 cm × 2 cm in the retro-areolar region of the left breast, which was insidious on onset, gradually progressive to the present size which is well defined with regular margins and not fixed to skin or chest wall. High-frequency ultrasound revealed a well-defined, mixed echogenic structure measuring 31.5 mm × 20.9 mm in the retro-areolar region, which had regular well-defined margins and wider than taller. No spiculations could be identified. Multiple reactive axillary lymph nodes with the largest measuring 11 mm × 6.2 mm with maintained hilum were seen in the axilla. Doppler examination revealed the presence of peripheral vascularity. Strain elastography revealed mosaic of blue and green on Tsukuba elastography color scale (score of 2) and strain ratio (SR) of 2.28; the imaging diagnosis indicated benign lesion of the breast. Fine-needle aspiration cytology examination confirmed the diagnosis of a benign fibrous histiocytoma of the breast. Radiograph of the chest was normal. Other laboratory parameters were normal.


  Discussion Top


Benign fibrous histiocytoma is composed of biphasic cells of histiocytes and fibroblast, which accounts for dual elements seen in the tumor. It is difficult to be diagnosed clinically when the lesion is in deep tissue. Noncutaneous fibrous histiocytoma constitutes only 1% of the benign fibrous histiocytoma.[2] Ultrasonography is a very useful noninvasive imaging method to assess tumoral pathology, providing key information, unavailable during clinical or histopathological examination. It gives real-time elasticity and vascularity of the lesions.

High-frequency ultrasound and conventional ultrasound offers necessary information regarding the size, morphology, elasticity, and vascularity, all of which are important to determine the prognosis and therapeutic approach of the lesion. The elastography uses a blue-green-red (BGR) scale (color-coded scale) to demonstrate various components of the histological structure, showing that elastography is a sensitive diagnostic tool to detect different malignancies, based on the principle that tumoral cells present a higher stiffness compared to the adjacent normal tissue.[3] The combination of conventional ultrasonography with elastography has refined differentiation between benign and malignant tumors of the soft tissues.

Tsukuba scoring system

Itoh et al. in 2006 gave an elastographic score for the diagnosis of malignant masses on sonoelastography. A score of 1 showed even strain for the entire hypoechoic lesion (i.e. the entire lesion was evenly shaded in green). A score of 2 means strain in most of the hypoechoic lesion, with some areas of no strain (i.e. the hypoechoic lesion had a mosaic pattern of green and blue). A score of 3 implies that strain at the periphery of the hypoechoic lesion, with sparing of the center of the lesion (i.e. the peripheral part of lesion was green, and the central part was blue). A score of 4 means no strain in the entire hypoechoic lesion (i.e. the entire lesion was blue, but its surrounding area was not included). A score of 5 indicated no strain in the entire hypoechoic lesion or in the surrounding area (i.e. both the entire hypoechoic lesion and its surrounding area were blue). BGR represents typical artifactual three-layered aspect (BGR) encountered with cystic lesions. In strain patterns, scores 1, 2, and 3 emphasized benign features whereas masses with scores of 4 and 5 were considered as malignant.[4]

Strain ratio measurement

A semi-quantitative method of lesion assessment, termed as SR measurement, is also used in elastography. Calculation of the SR value is based on determining the average strain measured in a lesion and comparing it to the average strain of a similar area of fatty tissue in the adjacent breast tissue. Using proprietary software, the average strain of the lesion is determined by selecting a region of interest encompassing the lesion; the value of SR increases as a function of the relative stiffness of the target lesion. With increase in SR, the likelihood of invasive breast cancer is also higher [Figure 1], [Figure 2], [Figure 3], [Figure 4].[5],[6],[7],[8]
Figure 1: Ultrasound of male breast revealed a well-defined, mixed echogenic structure measuring 31.5 mm × 20.9 mm in the retro-areolar region which had regular well defined margins and wider than taller. No spiculations could be identified

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Figure 2: Strain elastography of the mass showed mosaic of blue and green with score of 2 on Tsukuba elastography color scale and strain ratio of 2.28, indicating toward benign nature of the tumor

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Figure 3: On color Doppler, peripheral minimal vascularity is seen

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Figure 4: Intraoperative photograph showing breast mass

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  Conclusion Top


Benign fibrous histiocytoma of male breast is a rare tumor; sonography and elastography are useful imaging modalities in the diagnosis and management of these tumors.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to b'e reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prasanna Kumar D, Umesh, Rathi T, Jain V. Benign fibrous histiocytoma: A rare case report and literature review. J Maxillofac Oral Surg 2016;15:116-20.  Back to cited text no. 1
    
2.
Skoulakis CE, Papadakis CE, Datseris GE, Drivas EI, Kyrmizakis DE, Bizakis JG, et al. Subcutaneous benign fibrous histiocytoma of the cheek. Case report and review of the literature. Acta Otorhinolaryngol Ital 2007;27:90-3.  Back to cited text no. 2
    
3.
Crisan D, Gheuca Solovastru L, Crisan M, Badea R. Cutaneous histiocytoma-histological and imaging correlations. A case report. Med Ultrason 2014;16:268-70.  Back to cited text no. 3
    
4.
Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: Clinical application of US elastography for diagnosis. Radiology 2006;239:341-50.  Back to cited text no. 4
    
5.
Zhi H, Xiao XY, Yang HY, Wen YL, Ou B, Luo BM, et al. Semi-quantitating stiffness of breast solid lesions in ultrasonic elastography. Acad Radiol 2008;15:1347-53.  Back to cited text no. 5
    
6.
Marfani G, Phatak SV, Madurwar KA, Samad S. Role of sonoelastography in diagnosing endometrial lesions: Our initial experience. J Datta Meghe Inst Med Sci Univ 2019;14:31-5. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068818030&doi=10.4103%2fjdmimsu.jdmimsu_89_18&partnerID=40&md5=d420acd28b628a5fb55621fdd37838fa. [Last accessed on 2019 May 08].  Back to cited text no. 6
    
7.
Gulve SS, Phatak SV. Parathyroid adenoma: Ultrasonography, Doppler, and elastography imaging. J Datta Meghe Inst Med Sci Univ 2019;14:47-9. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85068703326&doi=10.4103%2fjdmimsu.jdmimsu_91_18&partnerID=40&md5=f9fb90ea92a03e3d196f1d182ea0eb8a. [Last accessed on 2019 May 08].  Back to cited text no. 7
    
8.
Phatak S, Marfani G. Galactocele ultrasonography and elastography imaging with pathological correlation. J Datta Meghe Inst Med Sci Univ 2018;13:1-3. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053321619&doi=10.4103%2fjdmimsu.jdmimsu_51_18&partnerID=40&md5=bfd00f99b99a6b702b42f5957dfcb4ab. [Last accessed on 2019 May 08].  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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