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Diffusion-Weighted Imaging of Mucinous Carcinoma of the Breast: Evaluation of Apparent Diffusion Coefficient and Signal Intensity in Correlation With Histologic Findings

Reiko Woodhams1,2,3,4, Satoko Kakita1, Hirofumi Hata1, Keiichi Iwabuchi1, Shigeaki Umeoka2, Carolyn E. Mountford3 and Hiroto Hatabu2

1 Departments of Radiology, Pathology, and Surgery, Kitasato University School of Medicine and Kitasato University Hospital, Sagamihara, Kanagawa, Japan.
2 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
3 Centre for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
4 Present address: Department of Radiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228-8555 Japan.


Figure 1
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  		Fig. 1 —Scatter diagram shows apparent diffusion coefficients of benign tumors (left), mucinous carcinoma (center), and other malignant tumors (right).

 

Figure 2
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  		Fig. 2 —Scatter diagram shows inverse correlation between tumor cellularity and apparent diffusion coefficient. Spearman's {rho} = -0.754, p = 0.001.

 

Figure 3
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  		Fig. 3A —75-year-old woman with mixed mucinous carcinoma of breast. Isotropic diffusion-weighted image with b value of 1,500 s/mm2 shows tumor as high-signal-intensity nodule with homogeneous structure.

 

Figure 4
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  		Fig. 3B —75-year-old woman with mixed mucinous carcinoma of breast. Apparent diffusion coefficient map shows area with low coefficient of 1.1 x 10-3 mm2/s (arrows).

 

Figure 5
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  		Fig. 3C —75-year-old woman with mixed mucinous carcinoma of breast. Photomicrograph of specimen shows dense tumor cell package with few surrounding mucous lakes. Intersecting thick fibrovascular bundles are evident. Mean cellularity is 67.0%. (H and E, x200)

 

Figure 6
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  		Fig. 4A —51-year-old woman with pure mucinous carcinoma of breast. Isotropic diffusion-weighted image with b value of 1,500 s/mm2 shows tumor with homogeneously low signal intensity (arrows) approximate to that of rib (arrowhead). Margin of tumor is indistinct.

 

Figure 7
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  		Fig. 4B —51-year-old woman with pure mucinous carcinoma of breast. Apparent diffusion coefficient map shows tumor as distinctive red area (arrows) with high coefficient of 2.0 x 10-3 mm2/s.

 

Figure 8
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  		Fig. 4C —51-year-old woman with pure mucinous carcinoma of breast. Photomicrograph of histopathologic specimen shows sparse tumor cell distribution surrounded by abundant mucus (arrows). No fibrous stroma surrounds tumor. Mean cellularity of tumor is 4.0%. (H and E, x200)

 

Figure 9
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  		Fig. 5A —66-year-old woman with pure mucinous carcinoma of breast. Isotropic diffusion-weighted image with b value of 1,500 s/mm2 shows tumor has heterogeneous signal intensity consisting of lobulated outline demarcated by high-signal-intensity margin and low signal intensity inside tumor.

 

Figure 10
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  		Fig. 5B —66-year-old woman with pure mucinous carcinoma of breast. Apparent diffusion coefficient (ADC) map shows high ADC component inside tumor surrounded by low ADC component at periphery (arrows) corresponding to high signal intensity in A. ADC is 1.9 x 10-3 mm2/s.

 

Figure 11
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  		Fig. 5C —66-year-old woman with pure mucinous carcinoma of breast. Photomicrograph of representative portion of histopathologic specimen shows thick fibrotic lobulated border at periphery corresponding to high-signal-intensity outline of tumor in A. Inside of tumor shows mucin lake containing tumor clusters. Cellularity inside tumor is 27.5%. (H and E, x200)

 

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