0:01

Our next case is a 37-year-old woman with a

0:04

recent diagnosis of right breast cancer,

0:08

and we're asked to evaluate extent of disease.

0:12

So this is the MRI for this patient.

0:15

The patient had presented with a

0:16

palpable mass on the right side, and when

0:18

this was evaluated with mammogram and

0:20

ultrasound, we found this large mass.

0:23

There were also segmental calcifications

0:26

in the right breast that were

0:29

concerning and had been biopsied.

0:31

So she had already had a two-site biopsy

0:33

showing that the mass was an invasive

0:36

ductal carcinoma and the segmental

0:40

calcifications were ductal carcinoma in situ.

0:43

So we'll investigate a little bit further.

0:47

And just looking at our T1 non-fat saturated

0:50

and post-contrast sub-images, we can see

0:54

the susceptibility artifact from the biopsy

0:56

clips here on the right inside this mass.

1:00

And then also a little bit more immediately,

1:03

we see susceptibility from a biopsy clip.

1:08

And that was at the site of DCIS.

1:11

And we can see also that there's

1:15

not only a large mass here,

1:21

but also non-mass enhancement

1:23

that extends from the

1:29

posterior aspect of the breast,

1:32

doesn't quite touch the pectoralis

1:34

muscle, like posterior breast.

1:36

all the way to the anterior breast.

1:41

And it really goes from

1:45

inferior to superior as well.

1:46

So pretty extensive non-mass enhancement.

1:50

And the other thing that we noticed was

1:52

that there are some very suspicious masses

1:56

in the breast, in the upper breast here.

2:04

There's another one here anteriorly,

2:11

and then another one

2:15

kind of lower anterior.

2:17

So these were all concerning for breast cancer.

2:21

And we considered this to be a BI-RADS 5,

2:24

you know, highly suspicious for malignancy.

2:26

We thought everything was suspicious and we

2:29

recommended additional biopsies if they thought

2:32

it would help affect management,

2:34

but a mastectomy was planned for this patient.

2:37

And my understanding is that she went

2:42

on to have bilateral mastectomy, mostly

2:45

because of her young age at diagnosis.

2:50

So, large extensive breast cancer,

2:53

and this was a BI-RADS 5.