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DCIS - discrepancy between mammography and MRI

Case contributed by Dr Sergey Kitaev

Presentation

No complaints, no palpable masses in the breasts. Presented for an annual check-up.

Patient Data

Age: 55 years
Gender: Female
Mammography

Right breast

In the upper outer-inner quadrant there are indistinct microcalcifications grouped in a linear pattern (enlarged on the magnification view). Coarse popcorn-like calcifications in the upper outer quadrant are consistent with involute fibroadenoma. No mass lesion detected.

Conclusion: BIRADS-4a, MRI recommended

No mass lesion detected on T1 and STIR series. Nevertheless, a conspicuous high signal of the glandular tissue is noted within the right breast on STIR.

On post-contrast T1 scan with subtraction there is a large abnormally enhancing area in the upper outer quadrant. The pattern of the enhancement is heterogeneous, predominantly linear or branching, arranged in different directions, interposed with small foci of fat. A distribution like this is of regional non-mass enhancement.

Conclusion: BIRADS-4. Core biopsy was recommended

Histology report: (immunohistochemistry with antibodies to CK5/6, estrogen, calponin): intraductal proliferation with atypia; the pronounced lymphoid infiltration of stroma around the ducts (presumably, explains the shining on STIR). Within the epithelial layer the expression of CK5/6 is missed, which agreed with DCIS. Myoepithelium all of the ducts exhibits an expression of calponin that excludes the presence of the invasive component. There is a moderate expression of estrogen in the ducts without any staining gradient in the intraductal proliferation that is consistent with DCIS.
Conclusion: pTis, DCIS, Grade 2.

Case Discussion

The discrepancy consists of the different volume of abnormality detected on the mammography and MRI where the former underestimates the extent of disease.

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