Infiltrating ductal carcinoma left breast

Case contributed by Dr Garth Kruger

Presentation

A routine MLO view of the left breast 2009.

Patient Data

Age: 65
Gender: Female
Mammography

Mass lesion in the axilla. Adjacent normal axillary lymph nodes. 

Mammography

One year follow-up

Axillary mass lesion is denser than the adjacent lymph nodes and has increased in size. 

Mammography

Two year follow-up

The patient is back for routine screening. The lesion is now bigger than on the previous studies and diagnostic workup is done.

Ultrasound

Solid lesion as tall as it is broad.

Case Discussion

On the initial image (2009( the lesion is way too radiodense to be  a lymph node, even with the benefit of the ubiquitous retrospectoscope. Lymph nodes on mammogram are invariably low density and have a fatty hilum or centre. A lesion this dense is a red flag even without previous imaging.

On the next image 2010, the lesion is slightly larger than a year ago. Second red flag.

On the last study, the lesion is clearly pathological. By now, the initially normal nodes in the vicinity are also denser than on the initial study.

The ultrasound study shows a solid lesion as tall as it is broad. Third red flag just went up.

This is in effect "time lapse" mammography that shows the development of an infiltrating ductal carcinoma over 3 years. The teaching point: not all lesions in the upper outer quadrant of the breast are lymph nodes. Nodes are low density and well defined, invariably with a fatty hilum or centre. Dense lesions should raise a red flag.  Enlarging dense lesions are doubly sinister.

Take a moment and compare this case with case 21438. The difference should be obvious.

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Case information

rID: 21440
Case created: 23rd Jan 2013
Last edited: 16th Dec 2015
System: Breast
Inclusion in quiz mode: Included

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