High grade ductal carcinoma in situ

Mammographic examination shows a coarse calcification that may be an expression of calcific fibroadenoma.

There are also multiple foci of irregular, amorphous microcalcifications, almost all of which are of the crushed stone type and some of which are mold-like, distributed in the super outer quadrant. The characteristics of the calcifications are suspicious of malignancy.

Fibroglandular Tissue (FTG): marked
Breast parenchymal enhancement (BPE): mild, more evident on the right.
In the context of the left breast after administration of paramagnetic contrast medium, there is an area of hypervascular parenchymal thickening extending craniocaudal for about 40 mm, with an anteroposterior diameter of about 26 mm and a transverse diameter of about 27 mm, whose intensity-time curve shows suspicious dynamic characteristics (wash-out dynamics). Another area with the same characteristics is found near the axillary extension (15 mm x 13 mm).
The larger area of enhancement shows close relationships with the pectoral fascia, in the absence of any appreciable signs of MRI infiltration.
Limited to the above findings there is a hypointense lesion in all sequences, with peripheral enhancement after administration of contrast medium to be referred to as a known calcific fibroadenoma.
Bilaterally appreciable multiple millimetric hypervascular foci in the phases after contrast, compatible with foci of hormonal activation.
There are no hypervascular lesions in the contralateral breast suspected to be foci of neovascularization.
Some lymph nodes with clear hilum coexist bilaterally in both axillary cavities.

The patient had undergone a tomosynthesis mammogram only 6 months previously, for initial hormone therapy, where the calcific nodule was appreciated, and some small calcifications were found adjacent to the nodule but were labeled as benign, and not investigated further.