Incidental invasive lobular carcinoma and incidental mature ovarian teratoma

Case contributed by Dr René Pfleger


Severe weight loss, loss of appetite. Problems with short term memory. Severely impaired activities of daily living including social and family interaction. No night sweats, no fevers, no focal symptoms. Symptoms lasting for more than 6 months.

Patient Data

Age: 85 years
Gender: Female

Non-contrast study due to reduced kidney function.

Incidental mass in right adnexa, containing macroscopic fat, calcifications and soft-tissue nodule resembling Rokitansky protuberance

Incidental nodule in right breast, not spiculated. No lymphadenopathy by size criteria. No bony lesions.

Incidental hypodense liver lesions, mostly resembling simple cysts.

Incidental finding of right breast lesion, not spiculated.

Incidental mass in right adnexa, mostly resembling mature ovarian teratoma: mainly fat density, eccentric Rokitansky protuberance, wall and peripheral calcifications.

Mammography and especially ultrasound characterize right breast lesion as malignant. Triple assessment positive.

Ultrasound revealed an ill-defined mass of heterogenous, hypoechoic architecture with posterior acoustic shadowing.

Right lumpectomy was performed and the patient made an uneventful recovery.

Pathology revealed invasive lobular carcinoma, grade 2, tumor diameter 21 mm. R0 resection. Focal vessel invasion. Endocrine receptor-positive (ER+ and PR+).  

Case Discussion

Patient history revealed that she had lost her daughter in a motor vehicle accident 9 months prior to the study. She was still mourning her loss, but stabilized. The significant weight loss was likely caused by situational or reactive depression.

Right lumpectomy was performed and the patient made an uneventful recovery.

Ovarian mass was left alone.

Incidental breast lesions on chest or chest and abdominal CT-studies are not an uncommon finding.  

In larger series 30% of incidental breast lesions proved to be unsuspected breast cancers, particularly irregular spiculated masses. Referral for formal triple assessment of CT-diagnosed breast lesions is worthwhile, and careful examination of the breast should be a routine part of CT examinations 1-3.

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