Ms. Jonikaite is a 40 year old female with recent history of left breast lumpectomy for malignant phyllodes tumor in 12/2015 with multiple positive margins. She presents today for MRI for further evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Expected postsurgical changes are identified in the left superior breast, at site of recent lumpectomy bed. There is architectural distortion and a nonenhancing seroma measuring 2.4 x 1.1 x 2.0 cm (AP times ML times SI). There is no gross abnormal enhancement seen surrounding the seroma cavity. However, extending inferomedially from this lumpectomy bed are three separate enhancing masses with suspicious MR appearance. The largest of these masses measures approximately 1.4 x 1.3 cm. The total span of these masses measures approximately 2.6 x 1.2 x 3.3 cm (AP x ML x SI). The AP oblique extent of these three masses combined measures approximately 3.9 cm. The closest of these masses is located approximately 0.5 cm medial to the lumpectomy site.In addition, there is an abnormal morphology left axillary lymph node measuring 1.8 cm.There are numerous T2 hyperintense lesions identified in both breasts, some of which enhance. These likely represent simple and complicated cysts in both breasts.There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in in the right axillary region.
(1) Expected postsurgical changes from recent left breast lumpectomy with three suspicious enhancing masses extending inferomedial from the lumpectomy bed. Total AP extent of these masses measures approximately 3.9 cm in the AP dimension. (2) Abnormal morphology left axillary lymph node. (3) No MR evidence of malignancy in the right breast.Of note, patient presented for an MR directed ultrasound shortly after the MRI. The findings and final recommendations from this MR directed ultrasound will be detailed in a separate report.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.