Invasive ductal carcinoma and ductal carcinoma in situ

Case contributed by Garth Kruger

Presentation

Screening exam. The patient has two sisters with breast CA and no previous breast imaging.

Patient Data

Age: 65 years
Gender: Female

In the initial study, there is a group of heterogenous microcalcifications inferiorly in the left breast. Mag views included; they are highly suggestive of DCIS. Confirmed on stereotactic biopsy.

But if you look carefully a spiculated density is also present superiorly in the left breast (see annotated image)

The ultrasound images are of the IDC. The lesion was confirmed as an IDC on needle biopsy. The second image shows Kopan wire localization pre-surgery. Note the beam "tilt" of the image. It's a handy feature if your machine has it. It keeps the beam tangential to the thin wire. 

One year later

mammography

The patient is back for imaging one year later. The post-surgical scarring is seen in the upper outer quadrant. The DCIS was removed by local excision. So far so good.

18 months later

mammography

18 months later, the left breast shows widespread calcifications from DCIS. Biopsy proven. Mag views are included.

Case Discussion

After the initial surgery for IDC and DCIS of the left breast the patient refused radiation and tamoxifen therapy. Recurrence of the DCIS in the left breast was not treated at the patient's instruction.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.