68-year-old woman with skin thickening and palpable lump in left breast
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Our next patient is a 68-year-old woman with
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left breast skin thickening and a palpable lump.
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So for this patient, we have CC (craniocaudal)
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views at the top of the screen, MLO (mediolateral oblique)
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views at the bottom of the screen.
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You can see a very normal-looking right
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breast, but the left breast is quite
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abnormal, very thickened skin throughout.
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There's a large central mass with
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a lot of calcifications in it.
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The details are not very clear on the left side,
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mostly because the mass is so large that we
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can't get adequate compression of the tissue.
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On the MLO views, you see a similar finding,
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pretty normal-looking right breast, and then,
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um, the left breast has thick skin and a large
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central mass and relatively poor compression.
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So just looking at this a little bit
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more closely, you can see all the
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calcifications there on the left side.
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These are tomosynthesis
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images through this breast.
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You can get a sense that there's There's
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large masses all through that central breast
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and some pleomorphic calcifications,
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even though these aren't the best mammographic
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images, there's a lot going on there.
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And then very, very thick skin.
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And our MLO view was just very difficult
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to achieve standard positioning here
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because of everything that was going on.
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This is the tomosynthesis study,
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which was really pretty difficult, but
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basically just showing this large mass.
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And, of course, we want to check out the other
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side and make sure everything looks okay there.
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And it does.
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We have the right CC view and
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tomosynthesis images through the right
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CC view, which are normal looking.
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And then we have the right MLO
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view, normal looking tissue there.
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And then tomosynthesis images through
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the right MLO view, very normal looking.
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So our next step in this patient was
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to do an ultrasound, which we did.
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And ultrasound is, as you can imagine, with
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a mass this large, is pretty difficult.
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We can see the thick skin here, and
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we can see part of this irregular
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hypoechoic mass, very vascular tissue.
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We're measuring the thickness of the skin here.
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It's 4.6 millimeters, which is thick.
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And really, it was very difficult to get adequate
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images of this mass just because of its size.
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And then we looked in the left axilla
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and there was a very large, um, abnormal
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looking lymph node, no fatty hilum,
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and some adjacent abnormal lymph nodes.
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There were three in that group.
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So, we considered this to be BI-RADS
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Category 5, highly suggestive of malignancy.
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Certainly consistent with inflammatory breast
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cancer, we recommended biopsy of the central
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mass and of the left axillary lymph node.
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This was invasive ductal carcinoma, moderately
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to poorly differentiated, and the axillary lymph
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node contained metastatic invasive carcinoma.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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