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. 2017 Jan 5;12(1):1–12. doi: 10.1016/j.radcr.2016.12.001

Table 3.

Differential diagnosis table for primary neuroendocrine carcinoma of the breast.

Diagnosis Mammogram Ultrasound MRI
Primary neuroendocrine carcinoma of the breast
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    High-density mass spiculated, lobulated, or indistinct margins
  • -

    Hypoechoic or heterogeneous mass

  • -

    Microlobulated margins

  • -

    Normal sound transmission
  • -

    T2 heterogeneous high signal. T1 heterogeneous low signal

  • -

    T1 C + FS: heterogeneous enhancement. Rapid initial enhancement and delayed washout
Invasive ductal carcinoma
  • -

    Irregular mass with spiculated margins ± pleomorphic or fine linear Ca++
  • -

    Irregular or lobulated hypoechoic mass

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    Thick echogenic rim/halo

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    Posterior shadowing

  • -

    Nonparallel orientation
  • -

    T2WI FS: hypointense

  • -

    T1 C+ FS: spiculated/lobulated heterogeneous mass

  • -

    Rim enhancement <50%

  • -

    Early intense enhancement

  • -

    Washout
Fibroepithelial lesion
  • -

    Oval, macrolobulated or round mass

  • -

    Isodense to breast

  • -

    Involuting calcify over time (“popcorn” shape)
  • -

    Circumscribed hypo to isoechoic mass

  • -

    Hyperechoic pseudocapsule (compressed adjacent tissue)

  • -

    Echogenic Ca++ may be seen

  • -

    Echogenic septations may be seen

  • -

    Peripheral and feeding vessels on Doppler
  • -

    T2WI FS: isointense

  • -

    T1 C + FS: oval/macrolobulated smooth enhancing mass

  • -

    Usually moderate rapid homogeneous enhancement

  • -

    May have nonenhancing internal septations
Focal adenosis
  • -

    Ca++ (60% amorphous/indistinct)

  • -

    Circumscribed mass
  • -

    Oval, circumscribed, hypoechoic solid mass ± Ca++
  • -

    T1 C+ FS: indistinguishable from parenchyma

  • -

    30% enhance
Abscess
  • -

    Ill-defined spiculated noncalcified mass

  • -

    Adjacent trabecular thickening due to edema

  • -

    Often subareolar or periareolar

  • -

    Ipsilateral adenopathy may be present
  • -

    Heterogeneous complex mass

  • -

    Surrounding increased echogenicity

  • -

    May have fluid/debris level or septation

  • -

    Surrounding hyperemia
  • -

    Not indicated for diagnosis

  • -

    T2 surrounding high T2 signal due to edema

  • -

    Rim enhancement due to hyperemia
Invasive lobular carcinoma
  • -

    Spiculated mass

  • -

    Multifocal or multicentric
  • -

    Irregular hypoechoic mass with posterior shadowing
  • -

    Spiculated mass or multiple small foci with connecting septae

  • -

    T1 C+ enhancing septae
Radial scar
  • -

    Long radiating spicules with intervening lucency

  • -

    33%–50% Ca+
  • -

    Irregular hypoechoic mass

  • -

    Architectural distortion

  • -

    Posterior shadowing
  • -

    T1WI: spiculated mass surrounded by fat

  • -

    T2WI FS: typically occult

  • -

    T1 C + FS: enhances
Stromal fibrosis
  • -

    Spiculated mass

  • -

    Architectural distortion
  • -

    Irregular hypoechoic mass

MRI, magnetic resonance imaging; FS, fat suppressed.