Wk 5, Case 3 - Review

HISTORY: 47 year old woman with a large rapidly growing painless R breast mass over the last month with redness, US biopsy proven IDC with metaplastic features metastatic to nodes. Triple negative.

Summary of prior imaging:

Mammography: Left breast – extremely dense otherwise normal. Right breast could not be imaged.
Ultrasound: Solid 8cm+ mass at palpable site outer right breast. Multiple enlarged right axillary nodes.
Breast MRI: NA

FINDINGS

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

Background Parenchymal Enhancement: Choose an item.
Amount of Fibroglandular Tissue: Choose an item.

LEFT BREAST

Narrative: Within the inferior retroareolar portion of the anterior 1/3 of the left breast is a well-circumscribed 23 mm cyst. No concerning areas for malignancy

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, ☐ Abnormal internal
mammary

RIGHT BREAST

Narrative: There is a large heterogeneous partially cystic mass measuring 11.2 x 7.8 x 8.9 cm occupying the majority of the middle and posterior 1/3 along the lateral aspect of the right breast with associated skin thickening. There is extension of the mass into the pectoral muscle with extension of the mass into the pectoral muscle with enhancement suspicious for invasion. There is a 1cm satellite nodule 8mm superior to the mass (series 6, image 125). 2.5 cm
anterior to the mass is another 1cm enhancing nodule (series 6, image 77). In the inferior breast there is a 4.5 cm segmental area of NME.

Right breast lesion 1
Lesion type: Mass (and satellite nodule)
11.2 cm. Upper outer Quadrant. 10:00 Radian. 7.1 cm from the nipple

Mass/post-surgical change: Shape:Oval/lobulated. Margins:Not circumscribed-irregular, Enhancement: Heterogenous. Kinetics: CANNOT ASSESS

BI-RADS:6: Known biopsy-proven malignancy – Appropriate action should be taken

Right breast lesion 2
Lesion type: Mass
1 cm. Upper outer Quadrant. 10:00 Radian. 2.5 cm from the nipple

Mass/post-surgical change: Shape:Oval/lobulated. Margins:Circumscribed, Enhancement: Heterogenous. Kinetics: CANNOT ASSESS

BI-RADS:4: Suspicious abnormality – Biopsy should be considered

Right breast lesion 3
Lesion type: Non-mass enhancement
4.5 cm. Lower Quadrant. 6:00 Radian. 7 cm from the nipple

Non mass enhancement: Distribution: Segmental, Internal enhancement: Clumped, Kinetics: CANNOT ASSESS

BI-RADS:4: Suspicious abnormality – Biopsy should be considered

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: There is associated confluent axillary lymphadenopathy measuring 5.6 x 3.6 x 4.4 cm containing a clip artifact. ☐ Abnormal internal mammary

Extramammary findings: None

SUMMARY: Locally invasive right primary carcinoma with a satellite lesion and an additional suspicious nodule, invading the skin and pectoralis muscle with extensive right axillary nodal masses. Skin enhancement raises suspicion of inflammatory breast cancer.

LEFT breast BI-RADS:2: Benign

RIGHT BI-RADS:6: Known biopsy-proven malignancy – Appropriate action should be taken

RECOMMENDATIONS: Oncological management. Biopsy of lesion 2 and 3 should only be performed if they will change surgical management. Lesion 2 likely visible by US, but Lesion 3 will likely require MRI biopsy.