Imaging Sciences Interesting Cases
Case 54
Jerry Lee, MD
Clinical Presentation: A 42-year-old women had trauma to the left breast 4 weeks prior. Patient palpates a left breast lump near the site of trauma. The patient has not had a recent mammogram or clinical breast examination. She denies routine self-breast examinations.
Imaging Findings: Screening mammogram demonstrates a large, high-density, well-circumscribed mass which measures approximately 10 x 12 cm in the upper outer left breast. The right breast is normal. The breast tissue is composed of scattered fibroglandular elements. Targeted ultrasound of the abnormality demonstrates a heterogeneous mass with vascularity.
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| Figure 1: Left MLO demonstrates a well circumscribed, high density mass in the upper left breast. |
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| Figure 2: Left CC demonstrates the mass in the lateral aspect of the left breast. |
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| Figure 3: Ultrasound demonstrates a heterogeneous mass with some internal vascularity. |
Diagnosis: Ductal Carcinoma
Discussion: Ductal carcinoma represents 65-80% of all breast cancers most common in patients over 40 years of age. Approximately 90% is sporadic and 10% is genetic. Clinically, there is a palpable thickening or firm lump on breast examination with abnormality on screening mammogram. The classic appearance is a dense mass with spiculated or microlobulated margins. Commonly there can be associated architectural distortion and calcifications, benign or malignant appearing. Ultrasound commonly demonstrates an irregular hypoechoic shadowing mass, taller-than-wide and can present with a dilated duct. Color doppler shows hypervascularity with penetrating vessels. Diagnosis is made with core biopsy. Extent of calcifications is important for surgical planning due to possibility of extensive intraductal component.
References:
- Kopans DB. Breast Imaging. 2nd Ed., Lippincott, Williams & Wilkins, 1998:107-34, 576-82.
- Dogan BE, Ceyhan K, Tukel S, Saylisoy S, Whitman GJ. Ductal dilatation as the manifesting sign of invasive ductal carcinoma. J Ultrasound Med. 2005 Oct;24(10):1413-7. [PubMed]