55-year-old woman with skin thickening and redness in right breast
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Our next case is a 55-year-old woman with redness
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and thickening of the skin of the right breast.
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So for this patient, we have CC (craniocaudal) views
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at the top of your screen, MLO
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MLO (mediolateral oblique) views at the bottom of the screen.
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And you can see comparing one side to the
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other that on the right side, we have diffuse
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skin thickening, you know, particularly in
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the anterior part of the breast compared
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to the normal skin on the left side.
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And there's a lot of asymmetric
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tissue throughout this central breast.
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No obvious mass there, but a lot of asymmetry,
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and it looks like the nipple, at least on
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the MLO view, is retracted or pulled inward.
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So we'll take a look at those
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images a little bit more closely.
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Here's the full right CC view,
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and when we image this a little bit closer
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up, you can see that there are some
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calcifications here in the central breast.
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And we'll look at the
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tomosynthesis images through this.
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There's a lot of increased density
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here, maybe a mass, and then
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there's some calcifications as well.
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Looks like there's probably a mass in here.
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And then on the MLO view, you know,
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we can see that the nipple is retracted
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and the skin is really quite thick
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anteriorly and in the inferior aspect,
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and there's a lot of density there.
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So our next step is going to
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be to look with ultrasound.
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I mean, we could get extra views of
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this breast, spot compression images,
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magnification views, but probably the
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ultrasound is going to be the most helpful.
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So here's our ultrasound.
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And when we scan this, there's it's
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thickening of the skin, and it looks like
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there's a, a mass that's hard to even see.
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We have this Sine image through it,
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but there's a lot of shadowing and hypoechoic
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tissue there in the central breast.
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It's possible that this
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entire area represents a mass.
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It's certainly infiltrating through the tissue.
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And this patient was not having
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symptoms of mastitis, but the skin
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was noted to be red and thick.
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And then looking at the axilla,
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there's an abnormal axillary lymph node with a
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thick cortex, and another lymph node that
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has a very thin cortex, but at least one
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lymph node with a thick cortex there.
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So in this situation, the thought was
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that this represented an inflammatory
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breast cancer rather than a mastitis.
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And the recommendation was for biopsy
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of the mass area in the right central
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breast and also ultrasound-guided
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biopsy of the thickened lymph node.
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And this was categorized as BI-RADS category
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five, highly suggestive of malignancy.
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And, um, the biopsy.
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Returned poorly differentiated
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infiltrating ductal carcinoma and
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metastatic disease in the lymph node.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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