Ms. Morris is a 64 year old female with biopsy proven multifocal malignancy of the right breast. Personal history of right breast lumpectomy/axillary dissection/chemoradiation for cancer in 1993. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.In the right lower inner breast, clumped nonmass enhancement is identified, spanning approximately 5.5 cm in the AP dimension. This MR-detected area of enhancement corresponds in distribution and span to the mammographically detected calcifications (spanning 5.9 cm in the AP dimension). Susceptibility artifact from two biopsy marker clips are seen spanning this area of clumped nonmass enhancement, separated by approximately 3.0 cm in the AP dimension, compatible with the history of biopsy proven malignancy. Located just 1.2 cm superior to the posterior aspect of the clumped nonmass enhancement is an additional irregular mass measuring 1.0 cm, suspicious for additional malignancy.Although there is moderate background parenchymal enhancement identified in the left breast, there are no foci more suspicious than the rest. No abnormal axillary lymph nodes are identified in either axillary region.
(1) Multifocal biopsy proven malignancy of the right breast, spanning approximately 5.5 cm in the AP dimension. Additional irregular mass, seen just 1.2 cm superior to the MR-detected area of enhancement, is suspicious for malignancy. Additional workup, including ultrasound and possible biopsy, can be performed if clinically warranted.(2) No MR evidence of malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.