43-year-old woman with right breast lump

 

Images

Doctor's Information

Name : Maryam
Family : Noori
Affiliation :Teb Azma Imaging Center,Ghom,Iran
Academic Degree : Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : ------------------

 

Case Section

Breast Imaging

 

Patient's Information

Gender : Female
Age : 43

 

Clinical Summary

A 43-year-old woman complained about right breast lump

 

Imaging Findings

MR- mammography findings: On T1w sequence, hypointense mass with ill defined border is depicted which surrounded by adipose tissue. On T2w, hyperintensity corresponds to peritumoral edematous zone. On contrast enhanced 3D subtraction images, centrally located, hypervascularized, ill-defined tumor with strong initial contrast enhancement & varying signal intensity curves, some demonstrating characteristics of malignancy (wash-out).

 

Differential Diagnosis

Invasive lobular carcinoma (ILC) Tubular carcinoma Granulomatous mastitis.

 

Final Diagnosis

Invasive ductal carcinoma.

 

Discussion (Related Text)

Invasive ductal carcinoma is defined as the most frequently encountered malignant tumor of the breast. The tumor cells initially develop in the terminal ducts and tumor cells infiltrate the basal membrane in a single place or in several places. Invasive ductal carcinomas possess a strong fibrotic component. In addition, an extensive intraductal component is often present which can involve an area more than one-fourth of that of the invasive tumor portion. In general the tumor form can be described as having a spiculated or circumscribed configuration. MRM findings of IDC are: Tl-weighted sequence (precontrast), Isointense signal behavior in comparison to surrounding breast parenchyma and therefore no specific changes allowing demarcation of lesion when located within parenchyma. When the lesion is surrounded by adipose tissue it is seen as a hypointense, occasionally round or ovoid, more often spiculated lesion with ill-defined borders. The spatial resolution of MR mammography does not allow the depiction of pleomorphic microcalcifications. T2-weighted sequence, In comparison to breast parenchyma the lesion shows similar or slightly lower signal intensity. Occasional exhibition of a peritumoral hyperintense edematous zone. Tl-welghted sequence (contrast-enhanced), almost without exception these lesions are round, ovoid, or spiculated and display a contrast enhancement behavior typical of malignancy. Lesion borders are often ill-defined. Ring-enhancement is seen in up to 50% of cases. occasionally with centripetal contrast kinetics. In the signal analysis 35% of lesions display a moderate and 60% a strong initial contrast enhancement. Very few lesions display only slight initial contrast enhancement (5%). In the postinitial phase a plateau is seen most frequently; less frequently one finds a wash-out phenomenon. A continuous signal increase in the postinitial phase rare. As a possible side finding one may see dilated tumor veins.

 

References

Practical MR Mammography, Uwe Fischer. Breast Imaging Cases, Catherine M. Appleton, Kimberly N. Wiele

 

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