Presentation
Left breast swelling for 1.5 months.
Patient Data
Both breasts of homogenous glandular pattern.
The left breast shows upper outer quadrant two irregular shape heterogenous infiltrative masses, with the following features:
- they extend from 1/2 to 3 o'clock axis
- each averaging roughly 37 x 20.7 mm and 25x13 mm.
- the depth of the lesions averaging 5 mm
- the distance of the lesions from the nipple averaging roughly 5 cm
- the distance between the two lesions averaging 7 mm with suspected infiltration of the intervening parenchyma
- few intralesional tiny calcific foci are noted
A pathologically enlarged ipsilateral left axillary lymph node which shows increase cortical thickness with slit-like hilum. Smaller lymph nodes are noted with mild eccentric thickening, suspicious lymph nodes.
No right breast masses.
Opinion:
Features of bifocal infiltrative left breast masses associated with ipsilateral suspicious axillary lymph nodes (BI-RADS 5).
Mammography with tomosynthesis shows:
Both breasts are of heterogeneous dense fibroglandular pattern (category C).
The left breast shows an upper outer quadrant focal asymmetry associated with architecture distortion as well as few tiny microcalcifications with related spiculated mass seen in tomosynthesis. Normal nipple and areola. No skin thickening.
Multiple suspicious left axillary lymph nodes.
No mediastinal lymph nodes. No pulmonary nodules.
Pathology (multiple US-guided cores)
Microscopic: mammary carcinoma consisting of moderate nuclear grade ductal cell component, exhibiting sheets and cords, infiltrating the surrounding stroma with productive fibrosis.
Immunohistochemistry: Strong positive (+++) for estrogen and progesterone receptors. Negative HER-2.
Conclusion: Invasive ductal carcinoma (NOS) grade II - left breast.
Case Discussion
Left breast bifocal infiltrative breast masses associated with ipsilateral level I suspicious axillary lymph nodes (BI-RADS 5). Pathology revealed invasive ductal carcinoma (NOS) grade II.
CT is least sensitive and specific to breast cancer detection and characterization. It is used for assessment of pulmonary or mediastinal metastases.
Digital breast tomosynthesis gives a better 3D image of the breast and higher sensitive than conventional mammography in detection of breast masses, especially in dense breasts.
Case courtesy Prof. Dr. Heba Hassan, Professor of woman radiology, Alexandria University, Egypt.
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