Ms. Szynal is a 55-year-old female with a personal history of right breast mastectomy in 2012 for DCIS, now presenting with new left breast cancer of ILC/LCIS. Family history of breast cancer in paternal grandmother. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, posterior depth, there is an irregular enhancing mass identified measuring 1.4 x 1.2 x 1.5 cm (AP times mL times SI). Susceptibility artifact from biopsy marker clip is seen within the central aspect of this lesion, compatible with biopsy-proven malignancy.Seen approximately 1.5 cm anteromedially, is an additional irregular enhancing mass measuring 2.0 x 1.5 x 1.6 cm. This is suspicious for an additional area of malignancy.RIGHT BREAST: The patient is status post right breast mastectomy. No abnormal enhancement is seen in the right reconstructed breast.No abnormal axillary lymph nodes are identified in either axillary region.
(1) Biopsy-proven malignancy of the left upper outer breast with appropriate clip placement.(2) Additional suspicious enhancing mass is seen anteromedial to the biopsy-proven malignancy. If breast conservation therapy is desired, then an MR directed ultrasound is recommended in order to find a sonographic correlate and subsequently biopsy the correlate. If no sonographic correlate is identified, then an MR guided biopsy may be required.(3) No MR evidence of malignancy in the right reconstructed breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.