Biopsy-proven DCIS in 2015 presents for staging. History of nipple discharge. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Spanning the anterior to posterior depth of the left upper outer quadrant is suspicious nonmass enhancement compatible with known DCIS. This extends from near the chest wall to the level of the nipple. Overall extent measures 13.7 x 4.6 x 3.8 cm. Given the nonmass enhancement pattern, this is favored to represent DCIS rather than invasive malignancy.In the right inferior breast near 6:00, a 5 mm enhancing focus with areas of high T2 signal adjacent to it may represent a cluster of cysts with rim enhancement versus a small papilloma with adjacent dilated fluid filled duct. An enhancing skin lesion is also present on the right inferior breast, likely benign, though suggest correlation with physical exam.No abnormal axillary lymph nodes are identified in either axillary region. Normal sized symmetric lymph nodes are in each axilla.
1. Extensive nonmass enhancement in the left breast spanning over 13 cm compatible with the patient's known DCIS. This extends from near the chest wall to near the level of the nipple.2. Enhancing focus in the right inferior breast is low suspicion. However, correlation with ultrasound is recommended, and if a solid vascular mass is seen, then biopsy should be performed. If only cysts are seen, or if ultrasound is negative, then a 6 month follow up MRI would be reasonable.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.