0:00

So this is a patient where we can sort of look at them.

0:06

The MIPS going to give us pretty much everything we need to know, I think.

0:10

But, yeah, let's get that loading.

0:15

Now, that's exciting.

0:21

And we're going to look at this up.

0:23

So this patient's history is...

0:30

is a 52-year-old woman with diffuse left breast swelling.

0:39

Stop.

0:41

So this is the left breast, clearly very asymmetric.

0:48

And...

0:53

I'm trying to get it to stop.

0:55

Not very successfully.

0:59

Why don't we bring up the quiz on this one before I make everybody throw up?

1:14

I think the image on the right,

1:16

the MIP, will show you pretty much everything you need to know.

1:38

So this one is diffuse DCIS.

1:41

You could have wondered about inflammatory breast cancer because it's so big.

1:43

But if you look at it, there is no skin enhancement here.

1:48

You know, this was DCIS.

1:50

No invasive carcinomas.

1:51

She obviously went to mastectomy,

1:53

but there's no skin enhancement and no

1:55

skin thickening, which is against inflammatory breast cancer.

1:58

Post-radiation effect,

2:00

if she'd had a history of right breast

2:02

cancer and radiation, then that would be in the differential.

2:05

But this is awfully, even for background parenchymal enhancement,

2:09

this is awfully dense enhancement.

2:12

I didn't show you, but I can show you the color on this patient.

2:16

You can see that a lot of it was fairly

2:18

progressive, but there certainly were some areas of washout in this patient.

2:23

And she had no history of surgery on the right side.

2:26

And previously, both breasts were normal.

2:28

So this was diffuse DCIS.

2:30

So, I'm just going to show you...

2:31

I'll show you a comparison case of a similar patient.

2:40

Just, again, how diffuse DCIS can be

2:44

a little challenging to look at sometimes, and you've always got to think,

2:47

is this asymmetric physiologically?

2:49

Is there a reason to be a asymmetric physiologically?

2:52

Because most patients will be relatively symmetric unless

2:57

they've had prior treatment or surgery to one breast,

3:00

or they have very asymmetrically distributed breast parenchyma.

3:06

So, this is another patient in this case.

3:09

She had a fair amount of background

3:11

parenchymal enhancement, even in her normal breast,

3:15

but you can see that it's clearly, significantly more in her right breast.

3:20

She was a high risk screener.

3:21

This was completely unknown about.

3:24

Again, this enhancement is very clumped.

3:27

Sometimes you'll see this and it will form...

3:29

this one doesn't, and it will form the typical

3:31

clustered ring type appearance, which is pathognomonic for DCIS.

3:36

This one doesn't quite get to that stage,

3:41

but you can see how it's kind of trying

3:43

to be clustered rings, but doesn't quite make it.

3:45

It may be a little bit.

3:46

So you see these little things here,

3:50

that's...

3:51

And let's just...

3:51

I'll just magnify that for you.

3:55

See that little ring-shaped structure right here in the middle?

3:59

That's trying to be clustered rings.

4:01

We have a lot of those and that's pathognomonic for DCIS.

4:04

So think twice about asymmetric background parenchymal enhancement.