Ms. Sollmann is a 34 year old female with a recent diagnosis of DCIS of the left breast. She presents today for MR imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate to marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.In the left upper outer breast, far posterior depth, there is an irregular enhancing mass identified measuring 1.1 x 1.5 x 1.3 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen just postero-lateral to this enhancement, compatible with biopsy-proven malignancy of the left breast. Although this mass is close to the pectoralis muscle, there is a discrete fat plane present between the mass and muscle. The pectoralis muscle is also of normal contour and enhancement pattern.In the left upper outer breast, there is heterogeneous masslike enhancement seen measuring approximately 4.3 x 3.1 x 3.6 cm. This corresponds to the mammographically detected global asymmetry. Susceptibility artifact from biopsy marker clip is seen at the inferolateral aspect of this mass, which is biopsy-proven to be a lactating adenoma. No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.
(1) Unifocal malignancy of the left upper outer breast. If breast conservation therapy is desired, the biopsy clip can be used for preoperative surgical guidance. Of note, the biopsy clip is located just postero-lateral to the MR-detected area of enhancement. (2) 4.3 cm enhancing mass in the left upper outer breast, which presumably represents the biopsy proven lactating adenoma (based on proximity of the biopsy marker clip). If patient has had prior mammograms, they can be submitted for confirmation of stability of mammographic findings. Alternatively, an US-guided biopsy can be performed. (3) No MRI evidence for malignancy of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.