Developing density in the left breast of a patient with a previous carcinoma

Case contributed by Dr Garth Kruger

Presentation

This 65 year old patient had a left IDC (infiltrating ductal carcinoma) left breast 6 years before. The initial lesion was treated with lumpectomy and local radiation. She gets annual follow up mammograms.

Patient Data

Age: 65
Gender: Female

Another in a series of cases to illustrate both pathology and management of breast pathology.

Post surgical parenchymal distortion is seen. Otherwise unremarkable study.

A subtle focal density has now developed.

The reader calls this lesion Birads III and suggests 6 month follow up. Do you agree?

In a patient with a previous IDC and a lesion that has developed, there is no place for Birads III. This lesion should be treated as a Birads IV lesion and is until proven otherwise, a cancer in the ipsilateral breast.

The lesion looks much the same on the 6 month follow up mammogram. The reader suggests retruning to the regular follow up schedule i.e. repeat in 6 months.

It is now a full year after the lesion appeared and was dubbed Birads III. The lesion is larger on mammogram.

This is now a concerning lesion on ultrasound, the lesion is solid, hypoechoic and poorly circumscribed. The lesion is incompressible with the transducer.

Case Discussion

Biopsy confirms an infiltrating ductal carcinoma.

The teaching point is this: whatever biological trigger  (genetic or environmental) is present in the patient that allowed the initial cancer to grow, is still present after the therapy. Any lesion that appears subsequently should be seen with significant suspicion. There is likely no place for a Birads III diagnosis in a patient with a previous carcinoma.

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Case information

rID: 21556
Case created: 31st Jan 2013
Last edited: 7th Feb 2016
System: Breast
Inclusion in quiz mode: Included

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