Doctors test for HER2 status by taking a sample of the cancer and sending it to a laboratory for analysis. While a doctor will certainly want to rule out cancer, the good news is that most breast lesions are noncancerous (benign), especially in females under the age of 35. American Cancer Society. Radiology. Findings are classified based on the risk of breast cancer, with a BI-RADS 2 lesion being benign, or not cancerous, and BI-RADS 6 representing a lesion that is biopsy-proven to be malignant. At-home biomarker tests can screen for fertility, heart health, STIs, and certain cancers. It may be benign or malignant. Scattered fibroglandular tissue refers to the density and composition of your breasts. Stage 4 refers to late stage breast cancer, which means it has spread to other parts of the body. In some contexts, hypoechoic may refer to areas which produce weaker reflections than might be expected for that type of tissue. Begin typing your search term above and press enter to search. Irregular hypoechoic masses in the breast do not always indicate malignancies. Doctors describe breast cancer that has receptors for estrogen as being estrogen receptor-positive, or ER-positive. 2 A and B).A prior ultrasound from an outside facility performed 7 years earlier had shown this mass to be larger and predominantly cystic (Figs. Students, learn to love the curves and flow of things it will help you notice more abnormalities. You may perceive a lump as a mass, growth, swelling, thickness or fullness. To confirm the breast cancer stage, they assess several different factors, including tumor size. 4. These masses differ in a number of ways: A hypoechoic mass can form anywhere in the body. At ultrasonography (US), purely or predominantly echogenic breast masses are rare. (2009). On ultrasound papillary . They typically appear as circumscribed masses on mammography, but they can be more accurately evaluated on ultrasound. Ultrasound is an important medical tool that helps doctors detect abnormalities and determine what should be done next. It was a 10 10 8 mm, irregular, indistinct and heterogeneous hypoechoic mass, which had no posterior shadowing. B, Ultrasound of this mass shows the typical appearance of a fibroadenoma (a solid hypoechoic oval mass). DOI: 10.3390/diagnostics6010002, Ihnatsenka B, et al. The 6 Best At-Home Hormone Test Providers in 2023, less echogenic (absorbs more ultrasound waves), more echogenic (reflects more ultrasound waves), appears gray or darker than surrounding tissue, appears lighter or brighter than surrounding tissue, made up of muscle or fibrous connective tissue, a fuzzy or irregular outline rather than smooth, an angular shape rather than rounded or oval, being deeper or taller than they are wide, having both hypoechoic and hyperechoic lines radiating from its surface. Your doctor will usually do further testing if an ultrasound shows a solid mass or what looks like abnormal tissue. 2 C and D).Constellation of ultrasound findings suggested a papillary lesion. American Cancer Society. PMID:30580368. However, hard cysts have a higher chance of being malignant than cysts filled with fluid. A breast specialist can learn much by how a breast mass feels. The cookies is used to store the user consent for the cookies in the category "Necessary". Ultrasound waves cannot see through the skull and other bony areas as well as they can in softer, tissue areas. Learn what causes breast fat necrosis and how it differs from breast cancer. Any enhancement is usually minimal or patchy. Immediately inform your doctor if you have any signs or symptoms, such as: See your doctor if you feel or see anything out of the ordinary. This involves a process called fine needle aspiration (FNA), where a small needle is inserted into the lesion and a sample is collected to send off for further lab analysis. They're also not likely to be painful, though they can be in some cases. (2009). Ultrasound operators use special techniques to tell the difference between benign and malignant breast masses. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. This cookie is set by GDPR Cookie Consent plugin. intramammary lymph node with prominent central fat replacement of the hilum: partly hyperechoic. Under the microscope, breast cancer cells may appear similar to normal breast cells. No, a benign breast tumor cannot become malignant. Ultrasonography of the kidney: A pictorial review. 1. American Cancer Society. Benign breast diseases constitute a heterogeneous group of lesions arising in the mammary epithelium or in other mammary tissues, and they may also be linked to vascular, inflammatory or traumatic pathologies. You say, it is not a lesion, it is a shadow of a frisbee that hit me one second later. One tissue type may have a different echogenicity than another. In the pancreas, cancerous tumors and a benign condition called pancreatic and peripancreatic tuberculosis (PPT) are hypoechoic on an ultrasound. How are breast lesions typically diagnosed? and spiculation, which probably has the highest positive predictive value for malignant breast cancer. WebMD does not provide medical advice, diagnosis or treatment. DOI: 10.1186/1477-7819-11-35. Sometimes it can be difficult to tell the difference between mastitis (inflammation of breast tissue) and inflammatory breast cancer, but mastitis often causes symptoms of fever, chills, and body aches. By clicking Accept All, you consent to the use of ALL the cookies. This cookie is set by GDPR Cookie Consent plugin. Only 3% to 6% of breast lumps are due to breast cancer. According to the BI-RADS lexicon [], a hyperechoic lesion is defined by an echogenicity greater than that of subcutaneous fat or equal to that of fibroglandular parenchyma.Only 1-6% of breast masses are hyperechoic and the great majority of them are benign. Cardeosa G. Clinical breast imaging, a patient focused teaching file. Thank. The diagnostic accuracy of ultrasound for the 219 DCIS lesions was 81.7% (179/219). It really comes down to: irregular margins, irregular shape, dark hypoechoic. Characterization of liver lesions by real-time contrast-enhanced ultrasonography. It's important to note that around 20% of breast cancers don't even show up on a screening mammogram. A breast lesion refers to an area of abnormal breast tissue. Ultrasound can help tell the difference between fluid-filled cysts, which aren't likely to be cancerous, and hard cysts that need further testing. Uterus. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. What does a solid breast mass mean? Solitary pulmonary nodule: Benign versus malignant. When used properly, it reduces the number of benign biopsies while allowing the . A doctor may recommend a biopsy to investigate a breast lump. Cancerous masses in the breast are often very firm, like a rock. When should you get Sonomammography done? Masses that affect organs, blood vessels, and nerves are commonly removed. The nucleus (center) of cancer cells can be striking, with nuclei that are larger and irregular in shape. You can learn more about how we ensure our content is accurate and current by reading our. Some of the features that show as a hypoechoic mass on ultrasound that are indicative of a malignant breast mass include: or a duct extension. Most women with fibroids will have more than one. Created for people with ongoing healthcare needs but benefits everyone. These cookies ensure basic functionalities and security features of the website, anonymously. These areas appear black on ultrasound because they do not send back any sound waves. Ultrasound works by sending sound waves toward the object being tested. 2018;16(2):1521-1528. doi:10.3892/ol.2018.8805. Some masses may appear spiculated with posterior acoustic shadowing. This term means "not many echoes." The appearance, or differentiation, of cancer cells is another factor in cancer staging. (2012). Things that bounce back some strong echos, show-up BRIGHT on the ultrasound. Those symptoms aren't associated with cancer. focal fibrosis involving the breast. Usually, special genetic studies are done as well. In your facebook picture there is a lesion on your forehead. DOI: 10.4103/0971-3026.54887. Last medically reviewed on June 27, 2022, Multifocal breast cancer is where a person has more than one tumor in one area of their breast. In this article, we discuss what a breast lesion is, what causes them to develop, and whether a noncancerous lesion is at risk of becoming cancerous. The lungs are also difficult to view with an ultrasound because theyre air-filled. These benign tumors may occur in almost 70 percent of women by the age of 50. The doctors also performed color Doppler US (CDFI) if a breast mass was detected, using . Real-time sonoelastography for the evaluation of testicular lesions. What does breast cancer look like on a mammogram? Any lesion classified as benign must be benign on both modalities. Figure Ultrasound-guided core needle biopsy was performed, All rights reserved. Hypoechoic. Lippincott Williams & Wilkins. in 1995. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. Medical test results can be hard to understand. (2010). They can occur in a healthy liver and may not cause symptoms. Children and adults can develop this tumor. [28, 31, 32, 33] Some cancers can mimic benign tumors and appear well defined. Hypoechoic masses with irregular shapes in breast sonograms are suspicious. What is a hypoechoic lesion in the breast? Papillary breast cancer is a rare and slow-growing type of breast cancer. A hypoechoic nodule in the breast. Solid masses of dense tissue are hypoechoic. NX means that the doctor was unable to assess the lymph node status. It has irregular borders, and may appear spiculated. Leung A, et al. They appear as light gray on the ultrasound. Benign breast lesions that mimic cancer: Determining radiologic-pathologic concordance. Healthcare professionals classify cancer cells that are close to resembling healthy cells as being low grade or well-differentiated. They refer to breast cancer that has receptors for progesterone as progesterone receptor-positive, or PR-positive. 2. Breast lumps: A breast lump is a growth of tissue that develops within your breast. They bounce back and create an image that can be seen on a screen. Cancer cells differ from normal cells in many ways. The area around the mass may be distorted. MX means that the doctor was unable to assess metastasis. A brighter rim on the outside of the mass is also common. Metastasis is when cancer spreads from its original location in the breast to distant parts of the body, such as the liver, lungs, brain, or bones. Often, there are extra nuclei rather than just one center. However, some findings are more common in one than the other. It is difficult to comment more specifically on the significance of 'hypoechoic' without . Multiple cholesterol granulomas of the breast: A case report and review of the literature. This is probably related to the patient's previous mastitis. Silkowski, C. Emergency Medicine Sonography: Pocket Guide to Sonographic Anatomy and Pathology, Jones and Bartlett, 2010. Can cancerous breast tumors be prevented? A 48-year-old male patient post total thyroidectomy with PTC recurrence. People with later stage breast cancers may need more treatment than those whose cancer is at an early stage. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. If the IMLN has completely lost its normal morphology in a way to appear as an irregular hypoechoic mass, then in this case it will be difficult to name it an IMLN. Breast calcifications are identified by a mammogram and may indicate breast cancer. Unlike other breast cancer types, lobular breast cancer doesn't form lumps in your breast tissue or under your arm. Importantly, cancer treatments are advancing all of the time, and each persons outlook is different. Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. Baek SE, Kim MJ, Kim EK, Youk JH, Lee HJ, Son EJ. Last medically reviewed on June 25, 2018. They often have irregular borders. Masses can be hypoechoic, hyperechoic, anechoic, or mixed.. Benign growths can cause pain, obstruction, and other complications. (2013). The benign lumps sometimes resolve on their own. . This does NOT necessarily mean that the lesion is cancerous but that it might be and this needs to . 1999;213 (3): 889-94. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center. Scientists dont know for sure why this is true. An ultrasound cannot tell whether a hypoechoic mass is benign or malignant, or what has caused it. Radiology. This often indicates that a nodule is full of solid, rather than liquid, components. Radiological appearances of uterine fibroids. Read more for our picks and how to choose the best test for. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. A breast specialist can learn much by how a breast mass feels. Breast lesions are extremely common occurrences, and these growths are usually benign. (2007) ISBN:0781764335. Other factors include the following: When staging a persons breast cancer, doctors will determine whether it has spread to nearby lymph nodes. (2015). Mediastinal tumors develop in the chest and are rare. They typically have clearly defined borders. All ten cases were excluded. Here is an overview of each breast cancer stage: When recommending treatment options for breast cancer, a doctor will take into account: Early detection and diagnosis of breast cancer can significantly improve a persons outlook. Many people have thyroid nodules (lumps). T refers to the size of the main, or primary, tumor. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. The overall 5-year relative survival rate for breast cancer is 90%. A 51-year-old Chinese woman was recalled for assessment following her third screening episode. In all cases of lesions other than those which are absolutely benign, real time review by the radiologist is mandatory. Lippincott Williams & Wilkins. Which is correct poinsettia or poinsettia? Can a Benign Breast Lump Become Cancerous? But opting out of some of these cookies may affect your browsing experience. What is birads3? Vascularity: When lots of extra blood vessels are seen, its bad. Celli N, et al. Sometimes a breast lesion may cause pain, along with skin changes and nipple discharge. Only 3% to 6% of breast lumps are due to breast cancer. In this instance, it will . 7 How is sonomammography used to diagnose breast cancer? Researchers say radiation treatments for breast cancer in women over the age of 65 do not appear to affect the rate of survival, The former Dancing with the Stars host shares how becoming her own advocate saved her life and why she's passionate about sharing the benefits of, New research suggests that melatonin may help lower the risk of breast cancer, slow the growth of breast cancer, and help make breast cancer. Radiofrequency ablation is another less invasive procedure that shrinks masses with electrical currents. breast angiomas 1. breast hemangioma: can contain hyperechoic components. N refers to whether cancer has spread to nearby lymph nodes. Paredes ES. Cancers often appear bright when looking at mammogram pictures. capillary angioma of the breast. 2005 - 2019 WebMD LLC. A machine records the sound waves. Fibroid tumors of the uterus are often found during ultrasound exams. Benign Breast Changes That Mimic Breast Cancer. Pancreatic and peripancreatic tuberculosis presenting as hypoechoic mass and malignancy diagnosed by ultrasound-guided fine-needle aspiration cytology. Understand the treatment options: Treatment for hypoechoic lesions depends on the cause and severity of the abnormality. This term means "lots of echoes." These areas bounce back many sound waves. Malignant tumors can sometimes grow back even after surgery and treatment. It will help you to better understand how they are diagnosed and what to do about them. The size of the tumor is only one of several factors that doctors consider when staging a persons breast cancer. 2 Does Fibroglandular density cause pain? Like ping sound used by a submarine sonar? Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. This means that people with this type of cancer are 99% as likely to survive for at least 5 years after a diagnosis compared to those without the condition. If a doctor suspects the lesion may be malignant, a core needle biopsy may be used instead. Can Breast Cancer Be Detected in a Complete Blood Count (CBC)? Article. ", INDIAN JOURNAL OF RADIOLOGY AND IMAGING: "Radiological appearances of uterine fibroids. Treatment for breast lesions depends on your age, the size of the lesion, and whether the tissue is changing. Breast. These areas appear dark gray because they don't send back a lot of sound waves. T4: The tumor can be of any size but is growing . DOI: Foschi FG, et al. Learn how we can help. Nevertheless, male breast cancer comprises approximately 1% of all breast cancers around the world, and accounts for less than 0.2% of all cancer-related deaths among men. Umm.. sorry, I just cant get my brain to think of breasts as horizontal and vertical 2D. Despite the benign ultrasound appearance, this was a new finding on mammography and ultrasound guided biopsy was performed. Certain lesions may also require careful monitoring depending on your age and other risk factors for breast cancer. Whats the Difference Between Cysts and Tumors? b A spot image of iodine 123 total body scan of the neck demonstrate a focus of abnormal radiotracer . 60-year-old female with history of prophylactic mastectomy and autologous flap reconstruction 14 years prior now presents with a palpable right breast mass. American Cancer Society. Follow-up scans help to ensure that if there is a new growth, its caught and treated as early as possible. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-1014. . The diagnostic accuracy of mass-like DCIS lesions was 90.1% (82/91), which was significantly higher than that in non-mass-like DCIS lesions [75.8% (97/128), P=0.007]. 2005-2023 Healthline Media a Red Ventures Company. (2020). What does a hypoechoic mass look like on an ultrasound? Mario J, et al. Regular checkups are important, because you may not have any symptoms at all. A doctor may discover a breast lesion during an imaging test, such as a routine mammogram, or an ultrasound that was initially ordered for another reason. On exam, other changes may be present as well. Other factors include the location of the tumor, whether it has spread outside of the breast, the appearance of the cancer cells, and the presence of hormone receptors. Management BI-RADS assessment category 4, suspicious; biopsy should be considered. Almost 25 percent of hypoechoic masses in the kidneys are benign (noncancerous) or indolent (grows slowly) cancer, such as: The most common malignant tumor in the kidney is renal cell carcinoma. Fibroids are not cancerous, but they can cause severe symptoms. the persons age, general health, and personal preferences. Thats a birads 5 cancer which I would core-needle biopsy. Contact, Privacy, Terms. Necessary cookies are absolutely essential for the website to function properly. We also use third-party cookies that help us analyze and understand how you use this website. In patients over the age of 40 years, both modalities are performed and interpreted in tandem. These are relatively common findings. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass. Fibroids are solid masses that are normally made up of fibrous connective tissue and smooth muscle. This means a sample is taken out, either by using a needle or through a cut in the skin. 2c).Needle biopsy yielded a vascular lesion that was possibly a capillary or lobular . CT scan confirmed the presence of a lesion measur-ing 13.9 12.9 6.1mm in the subareolar portion of the left breast (Figure1). However, everyones experience of breast cancer is different. Machida Y, Tozaki M, Shimauchi A, Yoshida T. Two distinct types of linear distribution in nonmass enhancement at breast MR imaging: Difference in positive predictive value between linear and branching patterns. These centers will stain darker with special dyes. Ultrasound: Basic understanding and learning the language. Its the dark area in the center, and its edges are very hard to define. In some cases, the underlying infection, inflammation, or condition may be treated. More than 20 percent of adults have a benign liver hypoechoic mass. Ultrasound finding: You are describing an ultrasound finding of the breast. as an oval shape with a thin, consistent capsule. Many benign breast diseases present with irregular hypoechoic masses that can mimic carcinoma on ultrasonography. The waves form the black and white image you see on an ultrasound screen. This doesn't seem great to me. Smooth surface is good, irregular is bad. Several factors can help differentiate the two. An early diagnosis is the best way to have a good outcome. These terms are used interchangeably. The surrounding tissue therefore looks brighter/lighter shades of grey. It makes up less, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. ", Korean Journal of Radiology: "Are Irregular Hypoechoic Breast Masses on Ultrasound Always Malignancies? These cookies will be stored in your browser only with your consent. They usually give the size in millimeters (mm) or centimeters (cm). By angular margins, he means, not smooth oval shape. Cancerous tumors also often have what's called rapid signal intensity. Beyond a physical exam, they may use mammograms, MRIs, and ultrasound to help with the diagnosis. Jiang X, Xie F, Liu L, et al. (A) Left radial breast sonogram. Ultrasound demonstrates an oval hypoechoic wider-than-tall mass. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Cancerous masses on MRI differ both in how they look and the length of time they appear (kinetics). Characteristics of common solid liver lesions and recommendations for diagnostic workup. Benign versus malignant solid breast masses: US differentiation. Some masses may require traditional open surgery. except in certain grade III Invasive ductal carcinomas; microlobulations: 75% Learn more here. . They show up as hypoechoic masses on an ultrasound. Ultrasound uses sound waves that are absorbed by or bounce off of tissues, organs, and muscles. Also perhaps the report says that the abnormal is solid. About 40 percent of women have this type of breast tissue. acute breast hematoma: from acute hemorrhage. The majority of breast lesions detected by ultrasound are hypoechoic. This website uses cookies to improve your experience while you navigate through the website. Many women with fibroids have no symptoms. Options may include:. [ 3] Gynecomastia and invasive ductal carcinoma (IDC) are classified as the usual male breast masses; other circumstances can then be considered unusual lesions. T3: The tumor is larger than 5 cm in width. Tumor size is an important factor when doctors are determining the stage of a persons breast cancer. Stavros AT, Thickman D, Rapp CL et-al. Zwingenberger A. First, don't panic 80 to 85 percent of breast lumps are benign, meaning they are noncancerous, especially in women younger than 40. Pathology demonstrated DCIS. Hard cysts are more likely to be cancerous. T1: The tumor is 2 cm or less in diameter. A nodule in her left breast, which had been seen during the first screening episode, had increased from 4 mm to 9 mm (Figs. Sometimes breast lumps develop that are benign (noncancerous). angiomyolipoma of the breast 3: rare lesion. In most cases, cancerous lumps are hard and stay put when you feel them. On a mammogram, benign tumors often appear round or oval (ellipsoid) with clear, well-defined edges. We also review treatment options for breast lesions. Objective The purpose of this study was to determine clinical and ultrasonographic characteristics of male breast tumors. Breast cancer, ultrasonography. Cysts are filled with air, pus, or fluids, and are usually benign. Healing time depends on the type of tumor and treatment. In some cases, breast lesions may be self-detected. However, correlation with the mammographic appearance, lesion location, and clinical history allows the need for biopsy to be determined. Mammogram or ultrasound? What does breast cancer look like? Ultrasound uses SOUND, sound-waves that bounce back as an echo. 6 What does a hypoechoic mass look like on an ultrasound? If a doctor suspects that a thyroid nodule may . Possible signs of malignancy may include irregular shape or margins, which are typically highlighted on imaging tests. Instead, you may see redness, swelling, and sometimes a rash on the skin of the breast. and spiculation, which probably has the highest positive predictive value for malignant breast cancer. Pathology Leiomyoma. That's especially true in women who have dense breasts. On an ultrasound report, the term "hypoechoic" refers to an area that appears darker in the images. Breast Ultrasound vs. Mammography: Which Is Best? 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. This means the area is solid. Structures are said to be hypoechoic when only low-level echoes are reflected from their internal contents, producing the darker grey areas of the image. A woman with scattered fibroglandular breast tissue has breasts made up mostly of non-dense tissue with some areas of dense tissue. a: breast ultrasound in a young woman to explore a palpable mass. (2013). Possible causes and risk factors for breast lesions may include: You may also be more likely to experience swollen or lumpy feeling breast during the premenstrual phase of your monthly cycle. Other scans are commonly used to check for tumors in these areas. Learn more. Ultrasound is a useful tool to see if any part of your body has changed from its baseline state. Learn how to tell the difference between a cyst and a tumor, as well as the cancer risk associated with each. Harmonics can also be used to image cysts or ducts and can help determine if a "lesion" is a true finding or not. (2009). These are also called echoes. A hypoechoic mass is an area on an ultrasound that is more solid than usual tissue. If an ultrasound finds a hypoechoic mass, you may have wondered what that means.. This is the amount of sound waves that are reflected or echoed back. Infections in the breast can cause redness and swelling. 4 Should I get an ultrasound if I have dense breasts? We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Ultrasound is helpful in the evaluation of breast masses that are palpable or present as a mammographic abnormality [1, 2].The echo pattern of breast lesions is categorized as anechoic, hypoechoic, isoechoic, or hyperechoic with reference to the subcutaneous fat in the American College of Radiology (ACR) BI-RADS [].The echogenicity of fat in the breast is at the middle of the gray-scale spectrum. All rights reserved. Compressable: Soft and squishy is good, hard is bad. Your genes and stage of life, from puberty to menopause, can all affect how your breasts develop, look, and feel. They may order additional diagnostic exams, such as imaging tests, to help determine whether the lesion is cancerous (malignant), and if treatment is required. According to the BI-RADS lexicon [1], a hyperechoic lesion is defined by an echogenicity greater than that of subcutaneous fat or equal to that of fibroglandular parenchyma. This term means "lots of echoes." Benign growths can cause pain, obstruction, and other complications. American Cancer Society. It doesnt always mean that something is wrong. According to the American Cancer Society (ACS), doctors use the following system to grade tumor size: Tumor size is just one of several factors that doctors consider when determining the stage of a persons breast cancer. Sclerosing adenosis (SA) of the breast has sonographic features similar to some malignant tumors, [13] and can present as a solid hypoechoic mass with unclear borders, irregular morphology, and . Breast calcifications (calcium deposits in the breast), especially when grouped in clusters, may be visible as well. Become a Gold Supporter and see no third-party ads. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. The most important features on a breast ultrasound are the smoothness and contour of the mass margins and the shape of the mass.
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