34-year-old woman, currently lactating, with palpable lump left breast
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So our next patient is a 34-year-old lactating
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woman with a palpable lump in the left breast.
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So this patient was seen for ultrasound first.
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So she had ultrasound of the palpable area
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of concern, which was in the left breast.
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And it shows this hypoechoic mass with
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a central, even more hypoechoic area
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and a lot of internal vascularity.
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And it's pretty large, about four centimeters.
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It's a little over four centimeters.
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In this plane, it's nearly five
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centimeters, so about two inches in size.
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And this was recommended for
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biopsy, which was performed.
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And this was a poorly differentiated
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invasive ductal carcinoma.
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The patient had not yet had a mammogram
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at that point, but came to my institution
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for care and a mammogram was requested.
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So the bilateral mammogram was performed.
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She had already had the mass in the left breast
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biopsy, so you can see this U-shaped clip there.
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But you can see the size of the
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mass compared to the size of her
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breast, so really quite a large mass.
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And she's not quite as compressible on the left
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side as on the right because of her large mass.
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And then the other thing that we
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noticed, you know, her breast tissue
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is very dense, and then she has fairly
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prominent lymph nodes in that left axilla.
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So, uh, we looked through everything
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with tomosynthesis. It really didn't
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give us any additional information.
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There wasn't anything suspicious,
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um, other than the lymph nodes.
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And we went ahead and did a test.
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Bilateral whole breast ultrasound.
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So here's the right side looking okay.
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Lymph nodes on the right are normal.
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And then we looked at the left.
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Here's the large mass that was already diagnosed.
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That's the echogenic marker
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clip that had been placed.
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And then, um, we didn't see anything else in
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the left breast and we went to the left axilla.
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And we started seeing some abnormal
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lymph nodes with thick cortex.
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So there were several.
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Lymph nodes in a row that had thick cortex.
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This one is 6 millimeters in thickness.
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53 00:02:37,215 --> 00:02:39,975 That one is almost a centimeter in thickness.
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So lots of abnormal-looking lymph nodes,
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several abnormal lymph nodes in the axilla.
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So we advised ultrasound-guided biopsy
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of one of the axillary lymph nodes,
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which was performed, and we actually
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got benign tissue at the time of biopsy.
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61 00:03:00,269 --> 00:03:03,420 So that was her evaluation with us.
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Um, she was a lactating patient,
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so she could have a breast MRI.
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And that was the next step that was performed,
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but not part of our diagnostic day evaluation.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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