PDF(Pubmed)
Abstract：
An 85-year-old Chinese lady presented with a 5-day history of a painless left breast lump. There was no fever, nipple discharge, or history of trauma. She had a past medical history of atrial fibrillation that was managed with an oral anticoagulant. Mammography demonstrated a dense mass in the upper outer quadrant of the left breast. Ultrasound showed an irregular, heterogeneous 4.7 cm lesion containing debris and cystic spaces with raised peripheral vascularity at the 2 o\'clock position, 3 cm from nipple. No internal vascularity was detected. This was managed as a haematoma and rivaroxaban was withheld. Follow-up imaging 3-weeks later showed persistence of the lesion. Bedside needle aspiration yielded haemoserous fluid with immediate reduction in size of the lesion. However, 2 weeks after aspiration, there was recurrence of the \'haematoma\'. Multidisciplinary review of the clinical history, examination and imaging was sought, and biopsy of the irregularly thickened areas with vascularity along the periphery of the lesion was recommended. Vacuum-assisted biopsy was performed, and histology returned as metaplastic carcinoma. A recurring \'haematoma\' should always prompt a search for a secondary cause, with features such as irregular thickened walls and papillary/nodular components requiring further evaluation with biopsy for histopathological correlation.
摘要：
一位85岁的中国女士，有5天的无痛性左乳房肿块病史。没有发烧,乳头溢液,或者外伤史.她既往有房颤病史，接受口服抗凝剂治疗。乳房X线照相术显示左乳房的上外象限有致密的肿块。超声波显示不规则，在2点位置，含有碎片和囊性间隙的异质4.7厘米病变，周围血管突起，距离乳头3厘米。未检测到内部血管。这是作为血肿处理的，利伐沙班被扣留。3周后的随访成像显示病变持续存在。床旁针头抽吸产生血浆液，病变大小立即减少。然而,吸入后2周，“血肿”复发。临床病史的多学科回顾，寻求检查和成像，建议对病变周围有血管分布的不规则增厚区域进行活检。进行了真空辅助活检，组织学恢复为化生性癌。复发性“血肿”应始终提示搜索次要原因，具有不规则增厚的壁和乳头状/结节状成分等特征，需要通过活检进一步评估组织病理学相关性。
