Breast cancer and multiple circumscribed masses

Case contributed by Alexandra Stanislavsky


Asymptomatic patient, screening mammogram. Round 8.

Patient Data

Age: 70
Gender: Female

There are multiple small circumscribed masses, several of which contain coarse "popcorn" calcifications. There is also an irregular, dense, circumscribed mass in the medial right breast, close to nipple.  Note the prominent, partially imaged lymph nodes in the right axilla.

Difficult to appreciate on this study is the additional finding of a subtle cluster of powdery calcifications in the upper outer quadrant of the left breast.

Additional workup views confirm the highly suspicious, spiculated appearance of the right breast mass with probable ductal extension towards the nipple.

Left breast calcification cluster is better seen, with indeterminate appearance, warranting biopsy.

Malignant looking right breast mass with satelite mass or ductal component extending to nipple. Abnormal thickening and lobulated contour of a right axillary lymph node is concerning for lymphatic metastasis.

Pathology result: 
Right breast U/S guided core biopsy: invasive ductal carcinoma.
Right axilla FNA: metastatic lymph node
Left breast stereotactic vacuum assisted core biopsy: intermediate grade DCIS

Case Discussion

Note that the "rule of 3" for benignity of multiple bilateral breast masses only applies to lesions that have similar appearances with likely benign characteristics.  That is, it applies to the several probable small fibroadenomas in this case, but not to the markedly different appearing spiculated right breast mass.

"Satisfaction of search" case with multiple benign distractors as well as bilateral malignant lesions.

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