38-year-old woman with palpable lump in right upper breast
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Our next case is a 38-year-old woman with
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a palpable lump in the right upper breast.
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So we have CC views on the top of the screen,
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MLO views at the bottom of the screen,
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and you can see the triangular skin marker here in
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the right upper breast, and there are coarse
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heterogeneous calcifications in a segmental
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distribution in the upper right breast.
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So let's take a closer look.
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Here's our right CC view.
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You can see all of these calcifications
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in a segmental distribution.
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Some of them have linear forms,
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coarse heterogeneous or pleomorphic.
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And we'll look with our tomosynthesis images.
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You can see those calcifications. And the
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palpable marker is a little bit away from
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them, but there's some density there as well.
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And then, um, we're going
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to go to our right MLO view.
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And again, you can see our
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triangular skin marker and our coarse
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heterogeneous segmental calcifications.
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And just scrolling through the tomosynthesis
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images, we can see that there's some
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increased density here, but also that large
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area of calcifications in the upper breast.
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And we have our left CC view just has
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heterogeneously dense breast tissue,
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but we want to make sure that there's
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nothing else that we're missing here.
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Everything looks good on that side.
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We had an MLO view as well
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and tomosynthesis images
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basically showing normal tissue.
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So our next step for this patient
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after reviewing the first images, we had
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magnification views of the calcifications.
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So here's our CC magnification view,
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showing the distribution and imaging
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the calcifications a little better.
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And then our MLO view, you can
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really see those calcifications.
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So a lot of coarse heterogeneous
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calcifications, but then at the edges.
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Um, they just keep going.
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There's some, uh, smaller
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calcifications extending posteriorly.
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Our next step would be to go to ultrasound,
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which we did, and, um, imaging the area
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where the patient felt a palpable mass,
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um, at the 11 o'clock position of the right
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breast, seven centimeters from the nipple.
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There is a hypoechoic heterogeneous mass
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here, uh, measuring about two centimeters
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that corresponded to what she was feeling.
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Um, we also saw some other
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little cysts in the area.
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And we also looked at the, um, axilla
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where we saw some lymph nodes that
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were sort of borderline thickened.
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A little bit over three millimeters in thickness,
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and then just looking at that mass
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again that the patient could feel.
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So there's a lot going on here.
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We thought there really wasn't anything on the
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left breast, but on the right breast we had a
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mass that the patient could feel, We had all
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of those calcifications that look abnormal.
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And then we do have some borderline
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thickened lymph nodes in the axilla
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that are probably abnormal as well.
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To make things a little bit easier for
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the patient, we went ahead and recommended
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ultrasound-guided biopsy of the palpable mass
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and stereotactic or tomosynthesis-guided biopsy
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of the calcifications in the right breast.
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We didn't specifically biopsy the
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right axillary lymph node at this time.
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I think she came back at a different time for
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that procedure, but the mass was an invasive
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ductal carcinoma, and the calcifications
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were grade three ductal carcinoma in situ.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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