46-year-old woman recalled for developing asymmetry in right breast
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So our next patient is a 46-year-old
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woman who was recalled for evaluation of a
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developing asymmetry in the right breast.
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So we have CC (craniocaudal) and MLO (mediolateral oblique) views from the screening
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mammogram on this patient, and we can see
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that there's a density here in the right
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upper and outer breast, and compared to
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some prior exams, this had really increased.
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Over time so that now it was quite
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apparent that there was a change here.
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If I just pull up some of the prior images,
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this is from a few years prior, you can see
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that although there was a little bit of density
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here, this really has developed over time.
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So, you know, we have a developing asymmetry
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that was recalled and we, uh, worked it up.
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With some additional imaging, and that was
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the CC and MLO spot compression views and a
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full lateral view according to our protocol.
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So this was the MLO spot compression
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view and the CC spot compression view.
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So you can see that that persists on both views.
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And this was the true lateral view,
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also showing this large area of asymmetric density.
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And we had tomosynthesis images through this area.
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You can see almost a nodular texture to
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this tissue, but definitely persistent.
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Tomosynthesis through the spot
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compression in the MLO projection,
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and there it is.
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And tomosynthesis through the spot compression
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in the CC or exaggerated CC projection.
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So we have a definite finding there.
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We thought this was large enough that we
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might be able to see it on ultrasound.
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So we went ahead and did an
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ultrasound, and this is what we found.
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So we found this echogenic area of tissue with
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a lot of little hypoechoic spaces within it.
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There it is in the radial projection and an
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anti-radial pretty large patch of tissue.
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A little bit of blood flow, not much,
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but we felt like this was a definite correlate
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to the mammographic finding, and that
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we could target a biopsy to this area.
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We gave this a BI-RADS 4, BI-RADS
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Category 4 assessment, um, suspicious,
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and we went ahead and recommended an
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ultrasound-guided biopsy of this area.
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So when we did the ultrasound biopsy, what we
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got as a result was PASH again, pseudoangiomatous
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stromal hyperplasia, and dense stromal fibrosis,
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which we thought was benign and concordant.
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So we've been following this since that time,
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and there really has been no further change.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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