45-year-old female patient with a left breast medullary cancer per outside hospital pathology, status post lumpectomy and complete axillary lymph node dissection 9/2014 with unoriented margins and 2 positive nodes. No adjuvant therapy. Assess for residual disease. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a mass in the 7 o'clock position of the left breast demonstrating heterogenous enhancement and a central focus of fat signal intensity, which may represent a component of fat necrosis. The mass measures 3.2 x 2.9 x 3.6 cm (AP x ML x CC) and is inseparable posteriorly from the pectoralis major muscle. There is associated skin thickening of the medial left breast, measuring up to 9 mm in thickness. An enlarged enhancing interpectoral lymph node measures 2.9 x 1.7 cm. There is soft tissue thickening along the left internal mammary chain that may represent an internal mammary lymph node with associated adjacent sternal enhancement. The soft tissue component measures 1.5 x 2.3 cm. There is an additional small area of peri-sternal enhancement superiorly that measures up to 1.2 x 1.0 cm. Post surgical changes in the left axilla compatible with lymph node dissection.There is no suspicious enhancement in the right breast. Note that evaluation of the right axilla is limited by patient motion artifact. Prominent right axillary lymph nodes are noted with diminished fatty hila, and with cortical thickening measuring up to 6 mm. There is an enhancing lesion along the inferior axillary skin may that represent an inflamed epidermoid inclusion cyst.
1.Large enhancing left breast mass compatible with recurrent or residual breast cancer with a possible component of fat necrosis. There is associated skin thickening. Enlarged left interpectoral node and left internal mammary enhancing tissue highly suggestive of metastatic breast cancer.2.Indeterminate right axillary lymph nodes. Prominent lymph nodes may be related to inflamed right axillary skin lesion versus metastatic disease. Suggest correlation with physical examination and consideration of right axillary ultrasound to evaluate for lymphadenopathy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.