Invasive breast cancer and contralateral distracting lesion

Case contributed by Alexandra Stanislavsky


First screening mammogram. No symptoms.

Patient Data

Age: 55 years
Gender: Female

Screening Mammogram


There is a rounded, circumscribed mass in the lateral aspect of the left breast.

There is also a subtle spiculate mass in the upper outer quadrant of the right breast.

Left breast workup views


Spot compression views of the left breast circumscribed mass further demonstrate a smooth margin with a hypodense halo. The appearance is favored to represent a benign lesion, usually a cyst or fibroadenoma.

Right breast workup views


Area of spiculation in the right upper outer quadrant persists on both CC and MLO spot views. The appearance is suspicious for malignancy.

Breast ultrasound demonstrates a gently lobulated, hypoechoic mass in the left breast 10o'c 3cm FN, and a shadowing spiculated lesion in the right breast 10 o'c 7cm FN, which is taller than it is wide and disrupts tissue planes.

Case Discussion

There is an obvious, circumscribed mass in the left breast, which was proven to be a fibroadenoma on biopsy.

There is also a more subtle area of spiculation in the right breast which was shown to represent invasive ductal carcinoma.

This case highlights the importance of a structured search pattern and "satisfaction of search" approach, in order not to miss a more subtle but significant finding.

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