Ms. Gattuso is a 36 year old female with a history of growing biopsy proven fibroadenoma of the right breast. She recently had a surgical excision of this mass with OSH final pathology of borderline phyllodes tumor with positive margins at the lateral and inferoposterior borders. She presents today for MR evaluation. There is extreme amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.In the right superior periareolar region, there is very minimal architectural distortion identified, likely related to recent surgical excision of biopsy-proven fibroadenoma (which appears to be a borderline phyllodes tumor on final surgical pathology). Few foci of susceptibility artifact are also seen in the right superior subareolar region, which may represent surgical clips. However, there is no residual post-surgical seroma nor is there any residual abnormal enhancement. There is moderate background parenchymal enhancement seen bilaterally, which precludes accurate measurement of previously characterized fibroadenomas. Of the four prior fibroadenomas that were measured on prior ultrasound examination, two are well seen on today's MRI:-right breast, 8:00 location measures approximately 1.1 x 0.9 x 0.8 cm (AP x ML x SI), previously seen to measure 1.1 x 0.6 x 0.9 cm-left breast, 3:00 location measures approximately 1.7 x 0.8 x 1.1 cm, previously seen to measure 1.3 x 0.7 x 1.0 cm. There is no abnormal enhancement seen in either breast. Multiple T2 hyperintense nonenhancing cysts are identified bilaterally, the largest of which measures approximately 1.0 cm in the right superior breast.No abnormal axillary lymph nodes are identified in either axillary region.
(1) Moderate background parenchymal enhancement, which limits the sensitivity of this examination.(2) Recent surgical excision of a borderline phyllodes tumor in the right superior breast with positive margins. No residual post-surgical seroma or abnormal enhancement is seen to suggest residual disease. Minor architectural distortion/possible surgical clips are seen in the right superior subareolar region. If pre-operative surgical guidance is needed, a right unilateral mammogram should be obtained now to ascertain the presence of surgical clips. If present, then this area with the clips can be mammographically localized prior to surgery.(3) No MRI evidence of malignancy in the left breastBIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.