A patient submitted outside study for review. Submitted for review are digital mammographic images (5/15/15), ultrasound images of left breast(5/15/15), images from ultrasound guided biopsy of both breasts and post-procedural mammographic images (5/22/15), breast MRI (6/2/15) performed at Advocate South Suburban Hospital. DIGITAL MAMMOGRAPHIC IMAGES (5/15/15):The breast parenchyma is heterogeneously dense. There is an oval mass with pleomorphic calcifications and an ill-defined anterior density in the left retroareolar region, measuring 45 x 22 mm (AP x LR) on CC view. Just posterior to the above-mentioned calcified mass, there is a circumscribed mass, measuring 33 x 18 mm. There are several benign appearing masses at lateral and medial aspect in the left breast.No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREASTS(5/15/15):In the left breast, there is a bilobed mass with calcifications in the posterior part of the mass, measuring 36 x 16 mm, corresponding the retroareolar mass on the mammogram. The distance between nipple and the anterior part of this mass is about 4 mm.Labeled as "Left Breast Areolar Area Long Lat/Med," visualized is a benign appearing hypoechoic mass measuring 22 x 11 mm, likely corresponding to the circumscribed mass located just posterior to the calcified mass.Benign appearing oval masses are detected at 3:00 position (9 x 5 mm), 9:00 position (14 x 8 mm), and 1:00 position (23 x 11 mm) in the left breast. The 1:00 mass is likely the same lesion as one that labeled "Left Breast Areolar Area Long Lat/Med."There is a hypoechoic mass measuring 19 x 15 mm in the left axilla, suspicious for metastatic lymph node.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF BOTH BREASTS AND POST-PROCEDURAL MAMMOGRAPHIC IMAGES (5/22/15):In the right breast, multiple benign appearing oval hypoechoic mass are detected; 10:00 position (13 x 6 mm, 9 x 6 mm and 6 x 3 mm), 12:00 position (6 x 3 mm), and 11:00 position (6 x 4 mm). A few benign appearing lymph nodes are detected in the right axilla.Ultrasound guided biopsy and clip placement was performed for the following lesions with appropriate needle placement;1. Benign-appearing mass at 9:00 position in the left breast2. Suspicious mass at subareolar region in the left breast3. Benign-appearing mass at 3:00 position in the left breast4. Suspicious left axillary mass5. Benign-appearing mass at 10:00 position in the right breastPer outside pathology report, the pathology result of suspicious mass at subareolar region and left axillary mass was malignant (IDC grade 3 with DCIS grade 3), and that for other masses was benign.Post-procedural mammograms show 3 marker clips in the left breast, including the one in the proven carcinoma, a clip in the left metastatic axillary lymph node, and a clip in the right 10:00 position.BREAST MRI (6/2/15):Breast MRI was performed with a protocol outlined in the outside radiology report.There is an enhancing bilobed mass measuring 41 x 20 x 28 mm (AP x LR x CC) at the left retroareolar region, consistent with proven carcinoma. Posterior portion of this mass shows rim-enhancement. Just posterior to this bilobed mass, there is a slowly enhancing mass, likely fibroadenoma. There are several slowly enhancing masses in the left breast, consistent with multiple fibroadenomata.In the left axilla, there are two enlarged lymph nodes, measuring 23 mm and 13 mm. A marker clip is present at immediately anterior to the larger lymph node.In the right breast, a hematoma is present at 10:00 position. No suspicious enhancement is seen in the right breast.No abnormal lymph node in right axilla.
1. Biopsy proven carcinoma in the left breast with metastatic left axillary lymph node2. Multiple fibroadenomata in both breasts (the mass located posterior to the proven carcinoma in left breast also appears like a fibroadenoma)BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.