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Invasive ductal carcinoma - parenchymal distortion

Case contributed by Garth Kruger


Diagnostic mammogram. A first nations woman presents with a palpable mass in her right breast

Patient Data

Age: 55 years
Gender: Female

This case only really has teaching value if you carefully look at the initial 4 images before submitting to the inevitable temptation of peeking at the others.

The reader saw the long slim thin "runners" radiating from a density in the breast. Concentrate on trying to visualize the runners only; ow go back to the mammogram above. This is key in finding subtle parenchymal distortions especially in a dense breast. Train your eye to search and find those long slim runners which are often your only clue to the underlying cancer.

I have crudely tried to show those runners and what they look like.

The carcinoma was huge and extended from 10 to 2 o'clock in the upper half of the breast. The patient had large metastatic nodes that we sampled by FNA at the same sitting.

Case Discussion

In your everyday breast practice, most carcinomas will present either with a mass lesion or microcalcifications. The third manner of presentation is parenchymal asymmetry or distortion.  Sometimes the distortion is there without a mass. In reality, this usually poses the biggest challenge to early diagnosis.

All is not lost. You can train your eyes to become used to what the distortions look like if you see enough of them. Here is another very subtle example of a distortion that turned out to be an IDC with node metastases.

Look at the annotated image and try and find these "runners" on the mammograms you read even if there is no asymmetrical density seen. The runners can be an early clue and ultrasound is your friend.

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