75-year-old man, BRCA2 carrier, with palpable lump in right breast
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Next patient is a 75-year-old man with a palpable
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lump in the right breast, and the patient recently
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learned that he's a BRCA2 gene mutation carrier.
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So that's pretty unusual.
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So, for this man with a palpable mass,
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we did a bilateral diagnostic mammogram.
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We put a triangular skin marker on the area
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of palpable concern, which was in the
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right breast, and it corresponds to this.
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Dense mass in the right upper outer breast.
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And incidentally noted, there was a dense
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mass in a similar position on the left side,
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which the patient and clinician did not feel.
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There's really not much in the way of
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gynecomastia, maybe a tiny little bit of
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tissue behind the nipple, but not much.
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The rest of the tissue is fatty.
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So, we went ahead and did an ultrasound for
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this patient, and this is the mass on the right,
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seven o'clock, two centimeters from the nipple.
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So there's an irregular hypoechoic mass,
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and we had, I think we have a little cine clip
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through it just to show that, and it is about
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1.7 centimeters in greatest dimension.
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And then on the left, we have
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this mass, also a hypoechoic mass.
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Here's our CineClip going through,
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and there's some measurements, so it's
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1.6 centimeters, so almost a mirror image of
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the one on the right side, so hypoechoic,
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kind of an angular to microlobulated
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border, and about the same size.
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And then lymph nodes looked fine.
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So we recommended ultrasound-guided
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biopsy of both of these masses, and they
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were both invasive ductal carcinomas.
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Male patient with new realization
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of BRCA2 gene mutation status.
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So he ended up being treated
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with bilateral mastectomy.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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