A patient submitted outside study for review. Submitted for review are: -Specimen radiographs dated 07/25/2016 performed at AMITA Health Cancer Institute. -Right breast ultrasound dated 07/22/2016 performed at AMITA Health Cancer Institute. For comparison,the following studies are available:-Left breast ultrasound dated 07/10/2013 performed at Hinsdale imaging center.-Screening mammography dated 03/14/2015 performed at Hinsdale imaging center.-Diagnostic mammography of the right breast dated 03/31/2015 performed at Hinsdale imaging center.-Diagnostic mammography of the right breast dated 10/20/2015 performed at Hinsdale imaging center. Three standard viewsScreening mammogram dated 03/14/2015 showed grouped calcifications in the right central breast posterior depth, associated with a 7 mm density. There is also a 4 mm cluster of tightly grouped calcifications in the retroareolar region slightly medially. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. The breast parenchyma is composed of scattered fibroglandular elements. Callback diagnostic mammogram of the right breast performed on 03/31/2015 showed pleomorphic calcifications associated with a mass in the posterior central right breast. The tight cluster of calcifications in the retroareolar region also noted. Both these areas appear suspicious. The patient was put on a six month follow-up schedule.Six month follow-up was performed on 10/20/2015, showing that both clusters of calcifications were increased in size and number of calcifications, and continue to be suspicious.Ultrasound performed 07/22/2016 showed an irregular hypoechoic area with shadowing in the right breast 2-3:00 position measuring approximately 16 x 10 mm with some internal blood flow. Right axillary ultrasound shows a single normal morphology lymph node. On the same date, mammogram was performed, but the images were not submitted for review.Report from the mammogram also talks about a cluster of segmentally distributed calcifications in the left breast which could be a laterality related typo error, however mammogram needs to be submitted for confirmation. Two biopsies were performed on 07/25/2016, right breast calcifications at 2 sites. -The biopsy in the right breast 12:00 position posterior depth specimen radiograph showed calcifications, and the final pathology showed invasive, pleomorphic lobular carcinoma and lobular carcinoma in situ, pleomorphic and classic types.-The biopsy of the right breast 2-3:00 position anterior depth specimen radiograph showed calcifications, and the final pathology showed lobular carcinoma in situ, pleomorphic and classic types.A postprocedure mammogram was performed, but the images were not submitted for review.IMPRESSION:Biopsy-proven invasive lobular carcinoma and LCIS (pleomorphic and classic types) at two sites in the right breast. Recommend MRI for further evaluation and staging. Mammogram from 07/22/2016 and postprocedure mammogram to confirm clip placement from 07/25/2016 to be submitted for review.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.Report Electronically Signed: 8/16/2016 9:10 AM Joshua Finkle, MDI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.Report Electronically Signed: 8/16/2016 9:35 AM Kirti Kulkarni, MD
Biopsy-proven invasive lobular carcinoma and LCIS (pleomorphic and classic types) in the right breast. See follow-up MRI for further details.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.