Wk 2, Case 1 - Review

HISTORY: 37-year-old woman with a history of right breast enlargement and erythema. She has undergone multiple rounds of antibiotics with minimal decrease in the degree of erythema.

Summary of prior imaging:

Mammography: Heterogeneously dense breasts. There is diffuse asymmetric trabecular and skin thickening of the right breast. There is no discernable mass in the breast. There are several enlarged abnormal appearing axillary lymph nodes.

Ultrasound: Targeted ultrasound was performed of the right axilla. Several enlarged lymph nodes with thickened cortices were identified corresponding to the mammographic abnormality. Subsequent biopsy of a lymph node revealed metastatic mammary carcinoma involving a lymph node.

Breast MRI: NA

FINDINGS

Quality control issues: ☒None ☐Poor/lack contrast bolus ☐Poor fat suppression
☐Susceptibility ☐Movement ☐Other: Click or tap here to enter text.
Background Parenchymal Enhancement: Mild Amount of Fibroglandular Tissue: Scattered fibroglandular tissue

LEFT BREAST

Narrative: Negative. No suspicious enhancement or lymphadenopathy.

Associated findings LEFT breast: ☐Nipple retraction, ☐Nipple involvement, ☐Skin
retraction, ☐Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory,
☐Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion

Non-enhancing findings LEFT breast: ☐High ductal signal pre contrast T1, ☐Cyst(s), ☐Hematoma/seroma, ☐Post therapy skin/trabecular thickening, ☐Non-enhancing mass, ☐Architectural distortion, ☐Signal void from clips

Fat containing lesions LEFT: ☐Fat necrosis, ☐Hamartoma, ☐Post-operative
seroma/hematoma with fat

Lymph nodes LEFT: ☒Normal axillary, ☐Abnormal axillary: description, ☐ Abnormal internal mammary: description

RIGHT BREAST

Narrative: There is extensive diffuse nonmass enhancement throughout the right breast involving nearly all of the fibroglandular tissue. The overall extent measures up to 13.6 cm (CC). There are of nonmass enhancement extends to the base of the nipple anteriorly. There is no abnormal enhancement of the pectoralis musculature. There is diffuse skin thickening throughout the right breast without enhancement in the dermis. There are multiple enlarged
right axillary level I and II lymph nodes. One of these nodes demonstrates focal susceptibility artifact compatible with a biopsy clip. There is a mildly prominent right internal mammary chain node.

Right breast lesion 1
Lesion type: Non-mass enhancement 13.6 cm. Diffuse throughout the right breast.

Non mass enhancement: Distribution: Diffuse, Internal enhancement: Heterogenous.

BI-RADS:5: Highly suggestive of malignancy – Appropriate action should be taken

Associated findings RIGHT breast: ☐Nipple retraction, ☐Nipple involvement, ☐Skin retraction, ☒Skin thickening, ☐Skin invasion-direct, ☐Skin invasion-inflammatory, ☐Pectoral muscle invasion, ☐Chest wall invasion, ☐ Architectural distortion

Non-enhancing findings RIGHT breast: ☐High ductal signal pre contrast T1, ☐Cyst(s), ☐Hematoma/seroma, ☐Post therapy skin/trabecular thickening, ☐Non-enhancing mass, ☐Architectural distortion, ☐Signal void from clips

Fat containing lesions RIGHT: ☐Fat necrosis, ☐Hamartoma, ☐Post-operative
seroma/hematoma with fat

Lymph nodes RIGHT: ☐Normal axillary, ☒Abnormal axillary: Multiple enlarged abnormal level I and II lymph nodes with thickened cortices, ☒ Abnormal internal mammary: Possible, mildly prominent right internal mammary lymph node.

Extramammary findings: None

SUMMARY:

1) Diffuse non-mass enhancement of the right breast measuring up to 13.6 cm in greatest dimension. MRI findings are highly suggestive of malignancy. BI-RADS Category 5.

2) Multiple abnormal level I and II axillary lymph nodes (previously biopsied demonstrating metastatic mammary carcinoma).

3) Possibly abnormal internal mammary lymph node
RECOMMENDATIONS: Ultrasound-guided biopsy of a site in the right breast if it would impact clinical management. Otherwise, clinical follow up with the surgeon or oncologist is recommended.