Teaching Case

A 38-year-old female patient with a history of multiple breast fibroadenomas presented with a new palpable mass in the right upper quadrant. Besides, she showed episodes of hypoglycaemia from insuline resistance.

The most relevance finding in digital mammography is a large, round mass with circumscribed margins and high density located in the upper quadrant of the right breast (Fig. 1).

Ultrasound revealed a 4 cm hypoechoic round lesion with posterior acoustic enhancement. The margins are circumscribed and central and periphery vascularization on colour Doppler was noted (Fig. 2).

PET-TC showed a heterogeneous FDG captation inside the tumour (SUV max 8, 8) (Fig. 3).

Breast MRI was performed and revealed a lobulated mass, isointense on T1-WI and highly hyperintense on T2-WI. The mass showed fast and heterogeneous contrast enhancement on initial phase and plateau enhancement in the late phase (Fig. 4, 5).
Other lesions were noted in both breasts and were suggestive of fibroadenomas.

The diagnosis was made with 14-gauge percutaneous core-cut biopsy guided by ultrasound.

Solitary fibrous tumours are rare neoplasms that were primarily described as originating from the pleura [1]. In recent years, SFTs have been described in various extrapleural sites, such as the mediastinum, pericardium, nasal cavity and paranasal sinuses and retroperiteneum [2, 3]. The average age of clinical presentation is 20-50 years with no gender predilection.

Most patients are asymptomatic or present symptoms related to compression of the palpable mass. Moreover, some cases are diagnosed with hypoglycaemia, due to insulin-like growth factor secreted by tumour cells of SFTs. Most SFTs have been reported to be benign, and complete surgical resection remains the treatment of choice. Nevertheless, approximately 10–15 % of them show recurrent and/or metastatic disease [2].

There are only ten cases reported in the mammary gland, none of them locally recurred and metastases were not seen [4].

On CT, SFTs shows typical appearance of well-defined, lobulated lesions with a geographic pattern of enhancement.
MRI features were relatively nonspecific [5]. The existing reports of pleural SFTs describe masses of predominant low or intermediate signal intensity on both T1- and T2-weighted images and on proton density–weighted images. However, high signal intensity on T2-weighted images has also been reported most often in extrapleural SFTs [2, 3].
A useful distinguishing imaging feature of SFTs is the presence of large collateral feeding vessels, which were clearly seen with CT, MRI and ultrasound.