Ms. Marshall is a 28 year old female recently diagnosed with inflammatory breast cancer of the right breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.RIGHT BREAST: Spanning the entire right breast is extensive clumped heterogenous enhancement, measuring approximately 6.2 x 9.7 x 12.6 cm (AP x ML x SI). Some of this enhancement does drape over the pectoralis muscle, although the muscle itself appears to be of normal contour and enhancement pattern. Of note, there are multiple vessels that traverse through the pectoralis muscle to supply the abnormal breast tissue. Associated findings include diffuse skin thickening/enhancement.LEFT BREAST: In the left lower inner breast, there is an oval enhancing mass identified measuring approximately 1.9 x 1.3 x 1.2 cm. In addition, there is an enhancing focus identified in the left retroareolar region measuring approximately 0.5 cm. Although there are multiple additional scattered foci seen in the left breast, this particular focus enhances greater than the remainder of the foci. The distance between the two enhancing lesions is approximately 3 cm in the SI dimension. AXILLAE: There are multiple abnormal right axillary lymph nodes identified, the largest one of which measures approximately 3.0 cm and contains a biopsy marker clip. In addition, there are several abnormal left axillary lymph nodes, the largest one of which measures approximate 1.9 cm and also contains a biopsy marker clip.
(1) Biopsy-proven inflammatory breast cancer of the right breast. 12.6 cm of extensive enhancement, some of which abuts against the pectoralis muscle. (2) Bilateral abnormal axillary lymph nodes, of which one on each side has been biopsied. Awaiting final pathology results.(3) 1.9 cm mass in the left lower inner breast. An MR-directed ultrasound with possible biopsy is recommended for further evaluation.(4) Enhancing focus in the left retroareolar breast. An MR-directed ultrasound can be performed to search for possible sonographic correlate. If no correlate identified, an MR-guided biopsy is recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.