Archived Case 51

This is a classic presentation of inflammatory carcinoma. This patient had a fairly rapid onset of redness and induration. Because the mass is so suspicious for cancer on the ultrasound (ie, it does not look like a complex fluid collection as one would see with an abscess), this was biopsied right away, yielding invasive ductal carcinoma.

Whenever mastitis is diagnosed after imaging, one should always recommend follow-up after antibiotics to ensure resolution of the imaging findings.

We don’t really need to confirm that this is cancer. It obviously involves the entire breast, and a mastectomy is indicated. The breast is mostly fat on the right, but it is true one will be able to assess for small mammographically occult tumors on the opposite side (assuming bilateral scanning).

However, MR is useful in the assessment of neoadjuvant chemotherapy. The mammogram and ultrasound can only assess for the size and appearance of the tumor as it responds (or doesn’t) to chemo. The MR can show enhancement as well, which often dimishes even when the bulk of the tumor looks the same by other criteria.