A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram dated February 23, 2015, Right post-procedural mammogram dated February 24, 2015, MRI and right axillary ultrasound dated February 26, 2015 and MRI dated February 27, 2015 performed at Northwestern Memorial Health Care. For comparison, prior mammograms and ultrasounds dating back to August 29, 2012 are available. BILATERAL DIAGNOSTIC MAMMOGRAM (2/23/2015): Two standard views of both breasts, and two spot magnification views of the right breast were obtained. The breast parenchyma is extremely dense ,which limits the sensitivity of the mammogram, unchanged in pattern and distribution. Two loosely grouped clusters of pleomorphic calcifications are present within the lower inner right breast. The anterior grouping of calcifications spans 1.9 cm, and the posterior grouping spans 1.6 cm. Total extent of calcifications in the lower inner right breast spans 6.5 cm AP x 3.1 cm transverse x 4.4 cm craniocaudal. The most anterior extent of calcifications resides approximately 2.7 cm from the nipple base. No dominant mass or areas of architectural distortion are noted in either breast. RIGHT POST-PROCEDURAL MAMMOGRAM (2/24/2015): Per outside report, stereotactic needle biopsy was performed at two sites within the lower inner right breast. Images from the stereotactic biopsy are not submitted, and thus appropriateness of targeting cannot be assessed.An hourglass-shaped biopsy marking clip is present within the anterior lower inner right breast, corresponding to the anterior biopsy site. An X-shaped biopsy marking clip is present within the posterior lower inner right breast, corresponding to the posterior biopsy site.BILATERAL BREAST MRI (2/26/2015): Bilateral breast MRI was performed without and with gadolinium per outside hospital protocol. This examination was non-diagnostic and was repeated the following day.RIGHT AXILLARY ULTRASOUND (2/26/2015): A targeted right axillary ultrasound was performed. Multiple normal morphology lymph nodes are present within the right axilla.BILATERAL BREAST MRI (2/27/2015): Bilateral breast MRI was performed without and with gadolinium per outside hospital protocol.A circumscribed enhancing mass is present within the upper slightly inner left breast measuring 0.7 x 0.6 x 0.6 cm. This mass demonstrates hyperintense signal on STIR sequences and benign persistent kinetics, highly suggestive of fibroadenoma. This likely corresponds to a benign morphology, hypoechoic lesion visualized on prior ultrasound examination dated February 19, 2014. Multiple scattered foci of enhancement are present throughout the left breast, compatible with background parenchymal enhancement.Within the right breast, there is susceptibility artifact from a biopsy clip within the anterior lower inner breast with mild surrounding enhancement. Susceptibility artifact from a second biopsy clip is noted within the more posterior lower inner right breast, also demonstrating mild surrounding enhancement. An area of linear, clumped non-mass enhancement is present extending posterior and inferior to the posterior biopsy clip, measuring 2.9 cm AP x 2.5 cm transverse, extending to the level of the pectoralis muscle. No enhancement is noted within the pectoralis muscle to suggest muscular involvement. Total extent of enhancement within the lower inner right breast is 4.8 cm AP x 3.6 cm transverse. A 1.9-cm fluid collection is noted adjacent to the posterior biopsy clip, compatible with hematoma from recent biopsy. Elsewhere in the right breast, scattered foci of background parenchymal enhancement are present.Incidentally noted are two T2 hyperintense lesions within the liver, likely representing cysts.PATHOLOGY: Per outside reports, the anterior biopsy site (hourglass shaped marking clip) resulted DCIS. The posterior biopsy site (ex-shaped marking clip) resulted IDC with DCIS.
1. Extensive calcifications within the lower inner right breast with corresponding non-mass enhancement on MRI. Biopsy clips from the two malignant biopsies are present near the anterior and posterior extents of the non-mass enhancement. Total extent of calcifications on mammogram is 6.5 x 3.1 x 4.4 cm (AP x ML x CC).2. Circumscribed, T2 hyperintense, subcentimeter enhancing mass within the upper inner left breast, likely representing a fibroadenoma. This mass is felt to correspond to a benign morphology mass on ultrasound examination dated 2/19/2014, and demonstrates stability dating back to 8/29/2012. Per outside reports, this lesion has demonstrated stability dating back to 2009.BIRADS: 6 - Known cancer. RECOMMENDATION:T - Take Appropriate Action - No Letter. 