A focal aymmetric density is present in the upper outer quadrant. This was recalled for a diagnostic mammogram.
What is your assessment?
The density does not persist on diagnostic views A density is seen in only one view. Recommend ultrasound for further evaluation A density is seen in the upper outer quadrant. Recommend ultrasound A density is seen in the upper outer quadrant. Recommend stereotactic biopsy A density is seen in only one view. Recommend MRI for further evaluation
The density is seen in the upper outer quadrant
On the diagnostic views, it is well seen on the lateral film, but not well seen on the CC view. However, it was seen on the original screening CC, and can be localized to the upper outer quadrant. The margins are indistinct.
This mass has indistinct mammographic margins and solid on ultrasound, and thus is suspicious. In order to be “Probably Benign,” a mass must be circumscribed on spot mags and be benign-appearing sonographically. This is not a classic spiculated mass, and still might be benign, so BI-RADS 5 is not appropriate
Take a look at the sonographic appearance again
The mass has hypo- and hyper-echoic areas. What do you think of the hyperechoic portion?
Likely fat-containing Likely contains calcifications Mixed echogenicity masses are more likely benign I have no earthly idea
The echogenic portion most likely represents tiny calcifications
There is no shadowing, but a confluent echogenic area may be seen with a high concentration of tiny calcs; in this case, so tiny that they are not seen mammographically. Fat within the breast has a hypoechoic appearance. Mixed echogenicity lesions are just as suspicious as hypoechoic lesions.
An ultrasound-guided core biopsy was performed. The pathologist reported papillary carcinoma with a hitch: it resembled ovarian cancer, so it was read out as either ovarian met or primary breast cancer. Check out the related case below.
A pelvic ultrasound was performed
This cystic mass was removed, and found to be benign. SO, the breast mass was a primary papillary carcinoma. This is a rare subtype (about 1% of all breast cancers). It usually presents as a palpable cyst with a solid component in a slightly older patient. Prognosis is generally better than that of Infiltrating Ductal Carcinoma, NOS.
