28 year old with biopsy proven left breast IDC and DCIS, grade 3, with metastatic left axillary lymph node. There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a strong enhancement at left nipple and periareolar region, measuring 22 x 30 mm (LR x CC), consistent with known Paget's disease. Diffuse non-mass enhancement is seen In the left breast, with overall measurement of 60 x 75 x 82 mm (AP x LR x CC), consistent with proven IDC with DCIS. An area of stronger enhancement at upper outer quadrant (30 x 15 x 19 mm) might suggest an invasive component. A marker clip is present at lower inner aspect and two clips are present side by side at far lateral axillary tail in the left breast. In the left axilla, there are two abnormally enlarged lymph nodes, measuring 19 mm and 13 mm. There is a metallic artifact from marker clip within the larger lymph node. No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region.
1. Diffuse non-mass enhancement in left breast with nipple periareolar enhancement, consistent with diffuse IDC with DCIS.2. Two abnormally enlarged lymph nodes in the left axilla, one of which is proven metastatic.3. No MR evidence for malignancy in the right breast or right axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.