A patient submitted outside study for review. Submitted for review are:1.Bilateral screening mammogram 6/8/20152.Bilateral diagnostic mammogram 6/19/20153.Right breast ultrasound 6/19/20154.Ultrasound guided right-sided biopsy 6/30/20155.Post procedure right-sided mammogram 6/30/20156.Ultrasound-guided right-sided wire localization 8/6/20157.Post procedure right mammogram 8/6/20158.Mammogram of surgical specimen 8/6/20159.MRI bilateral breasts 8/27/2015performed at Adventist Bolingbrook Hospital. For comparison,5/9/2014 screening mammograms are available. 1.Bilateral screening mammogram 6/8/2015: Linear scar marker overlying the right breast. Circumscribed 5 mm oval asymmetry in the right medial breast is slightly increased in size. Asymmetry in the anterior right breast is new. Patient recalled for diagnostic mammogram due to anterior asymmetry.2.Bilateral diagnostic mammogram 6/19/2015: Asymmetry in the right anterior breast again seen. Circumscribed mass in the right medial breast. Targeted ultrasound was performed of right anterior lesion.3.Right breast ultrasound 6/19/2015: 3 lesions identified at the 3:00 position. A 5 cm from the nipple, there is a 5 mm hypoechoic mass with adjacent vessels suspected to be an intramammary lymph node. At 4 cm from the nipple, there is a 3 mm hypoechoic mass. A 2 cm from the nipple, there is a 9 x 4 x 5 mm lobulated hypoechoic mass with associated vascularity.4.Ultrasound guided right-sided biopsy 6/30/2015: Ultrasound-guided core biopsy of hypoechoic mass 2 cm from the nipple was performed. Subsequent path showed this lesion to be a sclerosing intraductal papilloma associated with marked apocrine atypia. Biopsy of lesions at 4 and 5 cm from the nipple seen on prior ultrasound was recommended.5.Post procedure right-sided mammogram 6/30/2015: Biopsy clip identified in right anterior breast at site of focal asymmetry corresponding to the anterior asymmetry.6.Ultrasound-guided right-sided wire localization 8/6/2015: Ultrasound-guided wire localization was performed prior to excisional biopsy. 2 wires were placed at the 3:00 position, entering lesions 2 cm, 4 cm and 5 cm from the nipple.7.Post procedure right mammogram 8/6/2015: Post procedure mammogram showed 2 wires. The anterior wire was adjacent to the surgical clip. The posterior wire was adjacent to the enlarging circumscribed mass in the right medial breast.8.Mammogram of surgical specimen 8/6/2015: Two mammograms were obtained following excisional biopsies post wire localization. The first specimen of the anterior lesion showed increased density with an associated biopsy clip. Pathology revealed this lesion could represent DCIS grade 2 with focal necrosis. A second specimen of the more medial posterior lesion showed increased density. Pathology revealed this specimen to represent DCIS grade 2 with focal invasive ductal carcinoma grade 2. Margins of the first specimen were negative for invasive cancer or DCIS. Margins of the second specimen were negative for invasive cancer but positive for DCIS.9.MRI bilateral breasts 8/27/2015: Evaluation of the axilla is limited with normal-appearing lymph nodes identified. There is a seroma cavity in the right breast extending from the 2:00 to 4:00 position measuring 3.9 x 2.5 x 2.8 cm. There is minimal parenchymal enhancement bilaterally with a few small foci of enhancement in the left breast. No enhancement suspicious for residual or recurrent tumor.
Screening detected focal asymmetry in the right medial breast was initially evaluated with ultrasound and biopsied revealing a sclerosing intraductal papilloma with atypia. During ultrasound, two additional lesions were seen within the right medial breast. Upon biopsy results, excisional biopsy of all 3 lesions were performed with pathology revealing DCIS and IDC grade 2. Postsurgical staging MRI showed no residual or recurrent tumor.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.