Ms. Heth is a 67 year old female with a personal history of left breast lumpectomy x2 in 2006 for DCIS/ADH treated with tamoxifen therapy and a right breast excisional biopsy in 2015 for periductal chronic inflammation. Family history of breast cancer in paternal aunt, diagnosed at the age of 50. She recently had biopsy of an enlarged left axillary lymph node, which was positive for breast primary. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: Spanning the entire left central to inferior breast are numerous enhancing masses/nonmass enhancement measuring approximately 13.2 x 7.8 x 7.3 cm (AP x ML x SI). This enhancement extends up to within 1 cm of the left nipple base. The enhancement is greater than 2 cm from the pectoralis muscle border.RIGHT BREAST: There is no abnormal enhancement seen in the right breast.AXILLAE: In the left axillary region, there are 4 abnormal axillary lymph nodes identified, the largest of which measures approximately 2.0 cm and is biopsy-proven to be malignant. Hydromark clip is seen within this lymph node.No abnormal axillary lymph nodes are identified in the right axillary region.
(1) Numerous enhancing masses/nonmass enhancement spanning the entire left central to inferior breast, measuring up to 13.2 cm, highly suspicious for malignancy. If tissue sampling of this abnormal area is warranted, an MR directed ultrasound with biopsy can be performed.(2) Biopsy-proven metastatic left axillary lymph node with appropriate clip placement.(3) No MRI evidence for malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. 