32-year-old woman, 21 weeks pregnant, with palpable lump left breast
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Our next patient is a 32-year-old
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woman, currently 21 weeks pregnant,
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with a palpable lump in the left breast.
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So we're going to begin with, um,
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ultrasound, and then add a mammogram
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if we feel like it's necessary.
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For this patient, we performed an ultrasound
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of the area of palpable concern, which is at
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the left breast at the 11 o'clock position.
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In her palpable area, there's some cystic
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spaces here, but there's also a fairly
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large hypoechoic mass that looks a little
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different from the surrounding tissue.
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And the best measurements we
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could get of this were about
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2.4 centimeters, a little bit
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smaller in the other dimensions.
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And there was some internal vascularity.
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And this really doesn't have
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very circumscribed margins.
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The margins are a little bit microlobulated
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where we can see them, and then in other
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areas, it's difficult to see the margins.
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So the person who saw this patient
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recommended biopsy as a first step.
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Uh, ultrasound-guided biopsy was
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performed, and this was in a poorly
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differentiated invasive ductal carcinoma.
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The patient then went on to have
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a bilateral diagnostic mammogram.
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So this is the bilateral mammogram,
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uh, performed on this patient.
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And as I mentioned, the, um, biopsy had already
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been performed in that left breast mass.
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So we can see the clip here, the coil-shaped
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biopsy clip, and then the triangular
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skin marker over the palpable area.
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And there's not a whole lot that
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we're seeing with the mammogram.
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One of the reasons to do mammography would be
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to, you know, make sure that there's nothing
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else in this breast or the other breast.
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Her breast tissue is quite dense, which is
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why ultrasound is a good, um, starting place.
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And just to look at her tomosynthesis
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imaging, it's interesting.
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She has that fairly large mass in the left
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breast, and you do sort of see part of it.
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It looks like her clip is actually a little
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bit displaced, and then just looking at
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the other view, here's her triangle on her
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skin, and her mass is kind of back in here.
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We didn't see anything else on either breast.
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We ended up doing an ultrasound of both
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breasts just to be sure that there wasn't
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anything else we were missing because
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she was not going to be able to get
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an MRI to, to look at this more closely.
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So what we saw was that here was the
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mass in the left breast with blood flow.
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And then we were able to see that her clip
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was sitting off by itself here to the side.
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So we were able to give the option of
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placing another clip inside the mass
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if that was going to be necessary.
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And we were able to give a distance from the
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center of the mass to the clip, and that could
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be important if the patient was going on to
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neoadjuvant chemotherapy, where you would actually
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want the clip to be centered within the mass.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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