Teaching Files
Archived Case 15
Contributed by: Katherine E. Dee, MD -
Would you perform an ultrasound?
YesNo
A large palpable mass is present in the upper outer quadrant.
What is your assessment?
BI-RADS 2 - Benign - Likely an abscess or hematomaBI-RADS 3 - Probably Benign - Likely an abscess or hematoma. Would inquire about relevant history
and do a short interval follow-up following resolution of symptoms
BI-RADS 4 - Suspicious - Mixed solid and cystic mass. Cannot exclude malignancy. Biopsy recommended
BI-RADS 5 - Highly Suggestive of Malignancy. Mixed solid and cystic mass
If you called it BI-RADS 4, you still pass.
If there had been a history of trauma or infection, and if there had been no blood flow within the solid portions, one could consider abscess or hematoma, and performing a follow-up ultrasound after treatment would be reasonable.
Biopsy showed Squamous Cell Carcinoma. This is a very rare tumor to occur in the breast. Other rare tumors in the breast include adenoid cystic carcinoma, granular cell tumors, and sarcomas such as angiosarcomas.
This patient returned 3 months after surgery with a lump underneath her incision. An ultrasound was performed
What is your impression?
early local recurrancepost surgical infection
hematoma/seroma
This mass is similar to but smaller than the original tumor, with solid and cystic components. Doppler could help to identify any flow in the solid portions of the recurrence. Without a biopsy, it is impossible to rule out a postoperative hematoma/seroma this soon after surgery.