Carcinoma of the breast mimicking an areolar dermal lesion

Objective. This report describes the sonographic features of 2 patients with invasive carcinoma of the breast that sonographically mimicked benign epithelial cysts of the areola. Methods. We retrospectively reviewed 2 cases of invasive ductal carcinoma that initially were diagnosed as dermal lesions in the areola after sonographic evaluation. Results. Sonographically, the 2 lesions were centered between the echogenic lines of the deep dermis of the areola. Neither sonogram showed a deeper component arising from the underlying breast tissue that would suggest a breast origin. Conclusions. Lesions in the subcutaneous tissue superficial to the anterior pectoral fascia are extraparenchymal in origin and typically are benign. The areolar tissue, however, is not extraparenchymal because the dermis of the areola contains lactiferous ducts; these ducts extend from a more deeply placed mammary gland and are associated with modified sebaceous glands. All types of breast abnormalities, including malignancies, may affect deeper lactiferous glands and ducts and extend into the areola, independent of nipple involvement.