A patient submitted outside study for review. Submitted for review are MRI dated February 21, 2015, bilateral breast ultrasound dated February 24, 2015, and images from ultrasound guided left breast biopsy dated February 25, 2015, performed at SAAD Medical Services. No studies are available for comparison. MRI (2/21/2015): MRI was performed without and with gadolinium as per outside hospital protocol.There is diffuse skin thickening and edema of the left breast. Multiple enhancing masses with intervening non-mass enhancement are present within the outer slightly upper left breast, extending along the approximate two o'clock radian from the level of the nipple to the posterior breast. The largest mass is noted posteriorly, approximately 4 cm anterior to the pectoralis muscle, measuring 3.3 x 2.3 x 2.7 cm. Additionally, multiple dilated, enhancing ducts are present within this region of non-mass enhancement in the upper outer quadrant of the left breast. Total area of enhancement in the upper outer left breast is 10.5 x 4.4 x 8.3 cm. This enhancement extends to the nipple and involves skin anteriorly. No areas of abnormal enhancement are present in the right breast.Two enlarged, enhancing left axillary lymph nodes are present, with the largest identified measuring 3.0 x 1.7 cm.BILATERAL BREAST ULTRASOUND (2/24/2015):Images labeled right upper outer, lower inner, and upper inner quadrants of the right breast were submitted. No solid or cystic mass is identified. Images labeled scar demonstrate a subtle area of irregular hypoechogenicity within the lower outer quadrant. Images labeled right axilla demonstrate no solid or cystic mass. No abnormal lymph nodes are identified on this single image.Images labeled left axilla demonstrate two abnormal morphology lymph nodes, with the largest identified measuring 2.6 x 1.4 cm with effacement of the hilum and cortical thickening. Left whole breast ultrasound was performed revealing multiple masses within the last lateral breast, two o'clock position. Conglomerate mass measures 4.5 x 1.7 cm. The two additional hypoechoic masses are present on images labeled left lower outer quadrant measuring 1.1 x 1.3 cm and 1.2 x 1.4 cm. Images labeled left upper outer quadrant demonstrate an irregular hypoechoic mass measuring 1.6 x 1.3 x 1.0 cm. multiple images demonstrate dilated ducts measuring up to 0.6 cm within the left upper outer quadrant.IMAGES FROM ULTRASOUND GUIDED LEFT BREAST BIOPSY (2/25/2015): Images from left breast ultrasound guided biopsy were submitted, however evaluation is limited as no labeling is present on the images. Biopsy needle appears to be traversing a hypoechoic lesion on a few of these images. It is unclear whether a clip was placed at the time of biopsy.
1.Multiple enhancing masses, dilated, enhancing ducts, and non-mass enhancement involving the upper outer and lateral aspects of the left breast with associated skin thickening with axillary lymphadenopathy suspicious for inflammatory breast cancer. Total area of enhancement extends to the level of the nipple, and involves skin anteriorly, measuring 10.5 x 4.4 x 8.3 cm.2. Two enlarged left axillary lymph nodes. The largest measuring 2.6 cm.3. Images from left breast ultrasound guided biopsy were submitted, but unlabeled, limiting evaluation.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.