Carcinoma left breast

Case contributed by Dr Garth Kruger

Presentation

Screening mammograms in 2011 and 2012

Patient Data

Age: 76 years
Gender: Female
Mammography

Normal CC view left breast.

Mammography

Developing density centrally left breast.

Ultrasound

The two mammogram images are from 2011 and 2012 and the ultrasound image is from 2015.

Case Discussion

On both occasions 2011 and 2012  the MLO views were unremarkable. In 2012 the patient was recalled for additional imaging. The ultrasound study was read as normal and the patient was returned to screening.

In 2015 she returns for diagnostic mammography with a palpable mass in the left breast as well as nipple retraction. The patient has multicentric carcinoma of the left breast with positive axillary lymph nodes on FNA.

Teaching point: as a general rule, no post menopausal breast should be doing anything except involuting i.e. gland gets replaced by fat unless the patient is on exogenous hormone therapy. Carcinomas do not have to show a mass or calcifications on mammography: a developing density is a well known presentation.  The density may be very subtle and if you don't look at the oldest previous study you will miss them...... as you will if you simply look at last year's study.  The fact that the ultrasound is called "negative" means you need an additional study (MRI) or FNA/biopsy to confirm there is no malignancy. You cannot simply say normal ultrasound and return to screening.

Any postmenopausal breast that shows increased density or focal asymmetry deserves careful thought and work up.

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Case information

rID: 37652
Case created: 16th Jun 2015
Last edited: 8th Dec 2015
System: Breast
Inclusion in quiz mode: Included

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