Ms.Luella Baab, 45 years old, submitted outside study for review. Images performed at Advocate Lutheran General Hospital submitted for review: Mammogram 4/25/2016Ultrasound of 4/25/2016Ultrasound of 5/18/2016MRI 6/1/2016Images submitted for comparison:Ultrasound and mammogram 6/27/2013 MAMMOGRAM: 2 standard views of both breasts and 2 additional views of the left breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A palpable marker overlies the skin of the right upper outer left breast. There is a underlying 2.5 x 3.4 cm dense mass in the left upper outer breast, posterior depth.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. ULTRASOUND OF THE LEFT BREAST : Static ultrasound images are submitted for interpretation.In the left breast, 2:00 position, 11 cm from the nipple, there is a hypoechoic, irregular mass with associated internal and peripheral flow which corresponds to the palpable concern. No suspicious left axillary lymph nodes are identified.ULTRASOUND-GUIDED BIOPSY OF THE LEFT BREAST: Previously identified mass in the left breast 2:00 position is the target for the biopsy. Targeting appears appropriate.POST PROCEDURE MAMMOGRAM : A lock shaped clip is placed in the superior aspect of the mass in the right upper outer left breast. A focal asymmetry in the lateral and anterior aspect of the left breast on the exaggerated CC view is likely due to the summation artifact. MRI breast:Multisequence MRI breast imaging with and without 9 cc intravenous gadavist contrast was performed as per outside MRI breast protocol. The breasts are composed of heterogeneous fibroglandular tissue. There is moderate background parenchymal enhancement bilaterally. Kinetic analysis of these images was not possible. RIGHT BREAST:There is no suspicious enhancement in the right breast.LEFT BREAST:In the posterior upper outer left breast, 2:00 position, 8 cm from the nipple, there is a heterogeneously enhancing mass measuring 3.5 x 3.2 x 3.4 cm (LR x AP X SI). The lateral margin of this mass is the approximately 3 mm from the skin. There is no abnormal enhancement involving the chest wall. The subtle susceptibility artifact from the biopsy clip is the noted in the superior aspect of this mass.No additional suspicious enhancement is identified in the left breast.AXILLAE:No suspicious lymph node is identified.Incidental note is made of a 1.2 cm area of high T2 signal intensity adjacent to the anterior aspect of the right middle lobe in the lung.PER OUTSIDE PATHOLOGY:A. left breast at 2:00 lesion, ultrasound guided core needle biopsy:- Metaplastic carcinoma with an invasive focal glandular component, grade 3 and regions of the chondroid-like matrix production.- This result is concordant with the imaging findings.
LEFT BREAST:3.5 cm biopsy-proven unifocal malignancy in the left posterior breast, 2:00 position. Clip is at the expected position.RIGHT BREAST:No imaging evidence of malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.