Developing carcinoma left breast

Case contributed by Dr Garth Kruger

Presentation

Routine mammography form 2009 to 2013.

Patient Data

Age: 60
Gender: Female
Mammography

"Time lapse" mammography to illustrate the development of an infiltrating ductal carcinoma over a period of 4 years. Not all IDC present as a mass lesion. This case presents with progressive parenchymal symmetry with long slender "runners". This lesion is differentiated form a radial scar by the density centrally and with the appearance on ultraound. Contrast this case with the appearance of the radial scar

No abnormalities in 2009.

Mammography

Very subtle asymmetry with "runners' developing. Seen on the MLO view not the CC view. Note the development of slender "runners" radiating form the small mass lesion?

Mammography

The central density is visible in 2013 again with the spiculated periphery.  strangely best seen on the CC view this time.  Contrast the dense mass in the centre with the appearnce of a radial scar on mammography.

Ultrasound

Lesion with spiculated margins.

Case Discussion

The object of this case is not  unthinking use of the  all seeing "retrospectoscope", an instrument has 6/6 vision on hindsight. The teaching point here is to allow you to look at a case and train your eye to observe and recall the spiculated "runners" that radiate from a small solid lesion. You can train your eye to spot the "runners" and lead it to the mass even in a dense breast. This is a skill that you can aquire with practice and effort.

If you are reading mammograms in a busy noisy, distracting, overlit environment, you will miss these lesions most of the time. You need to review mammograms in an environment that allows you to concentrate on what you are doing.  No phone.

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Case information

rID: 21693
Case created: 12th Feb 2013
Last edited: 24th Dec 2016
System: Breast
Inclusion in quiz mode: Included

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