61-year-old woman with history of left breast DCIS 10 years ago. Annual follow up
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The next case is a 61-year-old woman with
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a history of left breast DCIS 10 years ago,
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and she's presenting for annual follow-up.
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So these are the routine views for this patient.
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She's had a lumpectomy on the left,
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she's had excisional biopsy on the
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right, so her scars are marked.
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She's had biopsies bilaterally,
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so there are biopsy clips in both breasts.
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And what caught my eye here on the
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left MLO view were these little areas
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of asymmetry in the lower breast.
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Her lumpectomy was in the upper breast.
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So we looked through these areas with
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tomosynthesis and it did look like indeed there
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were some asymmetries, maybe masses there,
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and those were new compared to a previous exam.
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We did some extra work with spot
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compression, you know, it definitely
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looks like there were two masses there.
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We thought on the CC view that
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these were probably lateral.
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Here's her lumpectomy site.
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It's a little hard to see them.
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I think maybe one of them is visible here.
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Did a spot compression CC trying to find them.
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I think we see one here.
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She went from just an easy
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follow-up the lumpectomy site to.
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You know, a search for additional
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masses that she hadn't had before.
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This was her lateral view, and
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we definitely thought there was
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something here and probably here.
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And we had similar views from the prior
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study that definitely didn't show this.
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You can see the distortion at her lumpectomy site.
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You know, there's her scar marker,
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that interrupted line on the skin,
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and then there's, you know, underlying
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distortion at the lumpectomy site.
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So this is really a different part of the breast.
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So we went ahead and looked with ultrasound,
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and we found one mass that was sort of mixed
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echotexture, hypoechoic and hyperechoic.
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At the three o'clock position.
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And then this at the four o'clock position, there
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was an echogenic mass with some blood flow in it.
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So these two areas were recommended for
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biopsy and both had similar pathology.
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It was invasive mammary carcinoma
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with ductile and lobular features.
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So she previously had had only
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a ductile carcinoma in situ.
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These were actually invasive cancers.
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So this was a recurrence in the same breast.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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