Ms. Jonikaite is a 40 year old female with a recent left breast lumpectomy for malignant phylloides tumor in 12/2015 with multiple positive margins. She initially presented with a palpable mass, first diagnosed with a fibroadenoma, then had additional surgery after continued growth of the mass revealed malignant tumor and she underwent left lumpectomy. She presents today for MR directed ultrasound for findings seen on recent MRI. On physical examination, skin scar is noted at the 12:00 location of the left breast. No mass is palpated in the left axilla or either breast.A targeted right and left breast ultrasound was performed for the MRI areas of concern and the left axilla. --Left breast: Surgical scar from recent left breast lumpectomy is identified in the left superior breast. However, no sonographic correlate is identified for the three additional enhancing masses seen extending inferomedial from the left lumpectomy bed. --Left axilla: In the left axillary region, an abnormal morphology lymph node with focal cortical thickening (4 mm) is identified, measuring approximately 1.8 x 0.7 x 1.7 cm.--Right breast: In the right breast 12:00 location, 5 cm from the nipple, there is a 8 x 6 x 12 mm clustered microcyst identified, which likely corresponds to one of the numerous cysts identified on recent MRI. No sonographic evidence of malignancy in the right breast.
(1) Patient had recent left breast lumpectomy for malignant phyllodes tumor with multiple positive margins. Recent MRI demonstrated three additional enhancing masses extending inferomedial from the lumpectomy bed. No sonographic correlate was identified on today's MR directed ultrasound. If breast conservation therapy is desired, an MR guided biopsy for one of these masses (presumably the furthest enhancing mass from the lumpectomy site) is recommended. (2) Abnormal morphology left axillary lymph node, corresponding to the MR detected abnormal lymph node. An ultrasound-guided biopsy with clip placement can be performed if clinically warranted.(3) No sonographic or MR evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.