Ms. Martinez is a 48-year-old female with multiple palpable right retroareolar masses, the largest of which was biopsied with pathology of hyalinizing intraductal papilloma. She presents today for further imaging evaluation with MRI. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.In the right superior breast, there are multiple lobulated enhancing masses identified, measuring approximately 4.6 x 3.0 x 3.9 cm (AP x ML x SI). The maximal dimension in the AP oblique direction (measured in the sagittal plane) is approximately 4.8, corresponding to the mammographically-detected measurement of 5.0 cm. The largest of these masses measures up to 2.5 cm and contains susceptibility artifact from a biopsy marker clip. In addition, just lateral to the right nipple base, is an enhancing focus, which may represent an additional focus related to the above-mentioned process versus background parenchymal enhancement. No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region.
Multiple lobulated enhancing masses measuring up to 4.8 cm in the maximal dimension, one of which is biopsy proven to be a papilloma. MRI extent of disease approximates mammographic extent of disease. If excisional biopsy is desired for additional tissue sampling, then two mammographically localized wires can be placed bracketing the lobulated masses. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.