54-year-old woman with palpable lump in left breast
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Our next patient is a 54-year-old woman
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with a palpable lump in the left breast.
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So here are the images for our patient.
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We have CC views bilaterally on the top of the
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screen and MLO views on the bottom of the screen.
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And there's a triangular skin marker in the
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left upper outer breast, and you can see it here.
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You can see this oval mass underlying
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the triangular skin marker.
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So we'll take a look at those images closer up.
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So here's our left CC view and then our
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tomosynthesis images of the left CC view.
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Just scrolling through, we can see that
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triangular skin marker here in the lateral breast.
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And then we've got an
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oval mass, but it has microloupulated
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margins, maybe even a little
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irregular in terms of its margins.
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I'm not seeing anything else in
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this breast except that mass.
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And then, uh, looking at the MLO view, we see the
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mass again, but we also see, um, a prominent lymph node
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kind of sticking out of the corner here.
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So we want to keep that in mind as we're
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scrolling through our tomosynthesis images.
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So here's our tomosynthesis, uh, stack.
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We can see that prominent lymph node here
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in the axilla and then, um, this oval mass
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corresponding to the area of palpable concern.
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And nothing else really
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prominent in that, uh, breast.
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And of course, we're looking at, uh, both sides.
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So we want to make sure that we look carefully
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at the other side as well and not fall
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victim to the satisfaction of search error
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because sometimes there may be something
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else that we need to pay attention to.
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So this is the right CC that I'm scrolling through,
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and then we'll go to the right MLO (mediolateral oblique) view
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and we'll look through that one as well.
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So normal-looking tissue.
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And some normal lymph nodes up here in
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the axilla, but nothing surprising there.
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So our next step for this patient is
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going to be to look with ultrasound.
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And here's our ultrasound, uh, for our patient.
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So we're looking at the area
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of palpable concern first.
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And it's at the 1 o'clock position,
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15 centimeters from the nipple.
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And we have this heterogeneous hypoechoic
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mass with those sort of lobulated borders,
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irregular borders, and it's pretty large,
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2.8 centimeters here,
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2.7 centimeters in the other
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direction, some internal vascularity.
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And then, of course, we went to the axilla as
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well because we had that prominent lymph node.
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So here's the lymph node that
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we were seeing on the mammogram
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2.4 centimeters.
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63 00:01:23,140 --> 00:01:25,380 And you can see here, this is a nice
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example of effacement of the fatty hylum.
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So you can see this echogenic.
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Hilum, but it's very much off-center.
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Part of the cortex is thin, but
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the rest of it is very thick.
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And this is an abnormal lymph node.
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So the cortex is up to 1.
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2 centimeters in thickness.
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And normal cortex, we start being concerned
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about a cortex at about 3 millimeters in a
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patient with a suspicious mass in the breast.
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So at 12 millimeters, this is really.
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Abnormal.
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So, our final BI-RADS category for this patient
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was BI-RADS 5, highly suggestive of malignancy.
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We recommended biopsy of both the mass in
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the left breast and the axillary lymph node.
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The mass in the breast was a poorly differentiated
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invasive ductal carcinoma, and there was a
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metastatic disease found in that lymph node.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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