Invasive breast cancer and multiple distractors

Case contributed by Alexandra Stanislavsky


Screening mammogram. Generally lumpy breasts, but no new symptoms.

Patient Data

Age: 50
Gender: Female

Several findings. There is a focal asymmetry in the medial, inferior retroglandular zone on the right.

On the left there are two circumscribed masses with margins partially obscured by breast parenchyma. There is also an impression of several smaller circumscribed low density lesions on the right.

Incidental note of a skin lesion projected over the retroglandular zone on CC. On MLO, it is seen at the upper aspect of the breast contour, consistent with skin location. It has a characteristic appearance with low density, lobulated shape and hypodense halo.

Previous mammogram (2 years ago)


Prior mammograms, two years back.  The right medial inferior focal asymmetry is new.  

Rounded masses were present previously on the left, though one of these was in a different location.

Mammographic workup


Spot views demonstrate persistent mass with spiculation in the medial inferior quadrant of right breast.

Spiculated mass with angular margins, corresponding to the right breast mammographic lesion. 

The left breast masses were confirmed to be cysts on ultrasound (not shown).

Case Discussion

Histology: Grade 3 IDC NST of the right breast.

Lesion located in a typical "forbidden zone" check area.

Prominent distractors on the left. A "satisfaction of search" approach is important.

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