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1 McGill University Health Center Montréal, PQ H3G 1A4,
Canada
2 Université Catholique de Louvain Cliniques Universitaires Saint-Luc
Brussels B-1200, Belgium
We read the article by Nakazono et al. [1] in the December 2003 issue of the AJR with appreciation. We would like to take the opportunity to report a different dynamic enhancing pattern of fibromatosis that we encountered in a patient with recurrent breast fibromatosis.
A 25-year-old woman was referred to us for possible recurrence of breast fibromatosis. She initially underwent surgery 2 years earlier. Clinically a firm and nonmobile lump was palpated in the right breast. Mammography showed a spiculated very dense mass, situated in the surgical bed, with probable muscle invasion; sonographic examination revealed a hypoechoic irregular lesion with acoustic shadowing. Recurrence of breast fibromatosis was suspected, and MRI was performed before surgery for a better analysis of muscle invasion. Bilateral examination was performed in the coronal plane. On contrast-enhanced T1-weighted images and subtracted images, the mass showed a strong enhancement with an extensive pectoralis major muscle involvement. On dynamic MRI, kinetic features showed type II (plateau) and type III (washout) curves (Fig. 1A, 1B). Recurrence was confirmed after extensive surgery with pectoral muscle resection.
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Fibromatosis of the breast is an uncommon disease, most often appearing as an aggressive lesion-mimicking carcinoma on mammography and sonography [2]. MRI appearance of breast fibromatosis has been rarely reported and is probably more protean. On dynamic MRI, Nakazono et al. [1] described a gradual enhancement thought to reflect the significant amount of collagenous tissue in and myxoid change of the tumor. Our case showed rapid enhancement on dynamic MRI with type II (plateau) and type III (washout) curves compatible with a malignant lesion [3]. Previous reports on musculoskeletal fibromatosis have described a more aggressive behavior of fibromatosis recurrences [4], which might explain the rapid enhancement observed in our case.
The main interest of breast MRI in cases of breast fibromatosis in our experience remains the accurate evaluation of pectoralis major muscle involvement; this was the reason that this examination was initially performed in our patient [5].
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Saga Medical School Saga 849-8501, Japan
We are pleased with the response to our article [1] and the presentation of different types of fibromatosis of the breast by Dr. Mesurolle and colleagues. It is interesting to know that fibromatosis of the breast can have a rapid enhancement and washout on dynamic MRI. Differential diagnosis from carcinoma may be difficult in such a case, although it lacked peripheral ring enhancement typical for breast carcinomas [2]. The difference from our case, which showed a gradual enhancement, was probably due to the difference in cellularity, the amount of collagenous tissue, and myxoid change in the stroma. At any rate, it was a pleasure to learn fibromatosis of the breast can have various faces. Thank you very much.
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  H. B. Neuman, E. Brogi, A. Ebrahim, M. F. Brennan, and K. J. Van Zee Desmoid Tumors (Fibromatoses) of the Breast: A 25-Year Experience Ann. Surg. Oncol., January 1, 2008; 15(1): 274 - 280. [Abstract] [Full Text] [PDF]
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