Breast mass (BI-RADS 5)

Case contributed by Mohammadtaghi Niknejad
Diagnosis certain

Presentation

Right breast palpable mass and nipple retraction on physical exam.

Patient Data

Age: 40 years
Gender: Female
mammography

A spiculated high-density mass is seen in the central part of the right breast causing surrounding parenchymal distortion and skin retraction (BIRADS 5).

Focal mass-like densities are also seen in the right breast's deep inner central and UOQ, suggesting satellite lesions.

ultrasound

A hypoechoic mass with irregular and spiculated margins and surrounding parenchymal distortion is noted in the near zone of 1 o'clock of the right breast, measuring 29x 15.5x 15.5 mm in diameter and volume of 3.6 cc.

There are also small masses with similar appearance around the mentioned mass, suggesting satellite lesions.

The shear wave elastography shows the mass and the stroma around the mass to be yellow and red (stiff), suggesting malignancy. Areas of central necrosis are suspected.

US-guided core needle biopsy

ultrasound

The patient underwent an ultrasound-guided core needle biopsy and samples were sent for histopathology evaluation.

pathology

Hematoxyline and eosin stain of tumoral breast tissue:

Infiltration of breast tissue by the proliferation of tumoral cells arranged in tubules or individual cells. Tumoral glandular formation with irregular borders infiltrates fat lobules. Explicit elastosis of breast tissue and peritubular fibrosis are evident. Neoplastic cells have large hyperchromatic nuclei.

Diagnosis: Invasive breast carcinoma of no special type

Pathologist: Dr Shiva Mohajeri, Sina Hostipal, Tabriz, Iran.

Case Discussion

Invasive breast carcinoma of no special type is the most common type of breast cancer (70-80%), with a peak age of presentation of about 50-60 years.

The masses are often hyperdense on mammography and hypoechoic on ultrasound evaluation, with irregular and spiculated margins. Fine internal calcification foci may be seen in one-third of the masses. Surrounding parenchymal distortion and adjacent skin thickening or retraction are usually observed, particularly in large or superficial masses. In addition, satellite lesions and ipsilateral axillary lymphadenopathy could be identified in advanced lesions.

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