Wk 2, Case 4 - Review

HISTORY: 38-year-old woman undergoing high risk screening due to recent diagnosis of her sister age 34 with breast cancer.

Summary of prior imaging:

Mammography: Extremely dense breasts, no suspicious abnormalities
Ultrasound: N/A
Breast MRI: N/A

FINDINGS
Quality control issues: ☒None ☐Poor/lack contrast bolus ☐Poor fat suppression ☐Susceptibility ☐Movement ☐Other

Background Parenchymal Enhancement: Moderate
Amount of Fibroglandular Tissue: Extreme fibroglandular tissue

LEFT BREAST

Narrative: There no suspicious masses, abnormal enhancement or areas of architectural distortion. Scattered foci of enhancement consistent with hormonal changes/FCD

Associated findings LEFT breast: X None ☐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: X None ☐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, Abnormal internal mammary

RIGHT BREAST

Narrative: Non-mass enhancement throughout the upper two thirds breast extending to the nipple anteriorly and to the axillary tail posteriorly. It is not associated with increased T2 signal. It abuts but does not invade pectoralis. The nipple appears enlarged and enhances intensely.

Right breast lesion 1
Lesion type: Non-mass enhancement
8 cm. Upper 2/3 breast 4:00-8:00, 0-7 cm from the nipple

Non mass enhancement: Distribution: Multiple regions, Internal enhancement: Clustered ring, Kinetics delayed-Plateau

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

Associated findings RIGHT breast: X None ☐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: X None ☐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: 1 cm right axillary node with diffuse cortical thickening, Abnormal internal mammary

Extramammary findings: None

SUMMARY: Clustered ring enhancement throughout the majority of the right breast consistent with DCIS. Mildly abnormal right axillary node suggests the presence of invasive disease.

RECOMMENDATIONS: Ultrasound and core biopsy of right breast (if no US abnormality, this could be done randomly due to the extensive enhancement. Ultrasound of the right axilla