31-year-old woman with palpable lump and skin redness in left breast
HIDEInteractive Transcript
0:00
Our next case is a 31-year-old woman.
0:04
with a palpable lump in the left breast
0:06
and redness of the left breast skin.
0:09
So this patient was over 30 years old.
0:13
She's 31.
0:13
So we started with a bilateral mammogram.
0:16
And we have our CC images on the top of the
0:20
screen and MLO views on the bottom of the screen.
0:24
And you can see right away,
0:25
comparing the two sides,
0:27
There is a lot of asymmetric density
0:31
in the left breast, particularly in the
0:34
upper part of the breast and lateral,
0:37
but also extending across the midline.
0:40
Her skin is thick.
0:42
She's really not as well compressed
0:45
on the left side as on the right side.
0:47
And you know, part of that is due
0:49
to the, you know, just the tissue
0:51
asymmetry and discomfort in this breast.
0:54
So we'll look at that left
0:56
side a little bit more closely.
0:59
Here's our CC view.
1:02
You can see the skin is a little bit thick.
1:05
There's a lot of asymmetry there.
1:08
We'll go through our tomosynthesis images.
1:14
We can see a lot of tissue density there.
1:17
No obvious masses really, but,
1:21
you know, definitely some tissue density.
1:22
There's a suggestion of
1:23
some masses here centrally.
1:26
And then looking at the MLO view, again,
1:30
lots of asymmetry in that upper, mostly in the
1:33
upper breast and on our tomosynthesis images.
1:40
We just have that sort of conglomerate tissue
1:43
there in the central upper breast with maybe
1:47
a suggestion of some more mass-like areas.
1:51
And of course, this is our chance
1:52
to look at the other breast as well.
1:54
So we just want to make
1:55
sure that that side is okay.
1:58
And here's our CC view
2:05
and our tomosynthesis views showing
2:09
some heterogeneous normal breast tissue.
2:23
And tomosynthesis images through the right MLO (mediolateral oblique) view,
2:27
but really, the tissue looks okay on this
2:33
side, much more abnormal-looking on the left.
2:38
So we went ahead and did an ultrasound.
2:42
That's the next step.
2:45
And really wanted to focus on this left side here.
2:49
So this is the left breast in
2:51
those areas that are palpable.
2:53
And you can see that there are
2:54
multiple hypoechoic masses.
2:56
Um, that are interconnected with
2:59
these kind of tubular connections.
3:03
And here's one of the palpable areas that
3:06
was a little over two centimeters in size.
3:10
Lots of blood flow to this whole area and a
3:14
thick lymph node, lymph node with a thick cortex
3:18
measuring up to seven millimeters in thickness.
3:23
So this was really suspicious for breast cancer.
3:29
The skin is thick, it was inflamed,
3:32
there were multiple interconnected masses, and an
3:35
abnormally thickened um, lymph node cortex.
3:40
So biopsy was recommended for one of the masses
3:45
and for the large left axillary lymph node.
3:49
And the result was acute and chronic
3:53
inflammation with non-necrotizing
3:56
granulomas with surrounding cystic spaces
3:59
and associated neutrophils suggesting
4:02
cystic neutrophilic granulomatous mastitis.
4:05
And that's the one that's sometimes
4:06
related to the Corynebacterium infection.
4:10
And the lymph node was found to
4:12
be reactive, so no malignancy.
4:15
This was all granulomatous mastitis.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
© 2024 MRI Online. All Rights Reserved.