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  • BREAST-DIAGNOSIS
Breast Dx CaseBreastDX-01-0001BreastDX-01-0002BreastDX-01-0003BreastDX-01-0004BreastDX-01-0005BreastDX-01-0006BreastDX-01-0007BreastDX-01-0008BreastDX-01-0009BreastDX-01-0010BreastDX-01-0011BreastDX-01-0012BreastDX-01-0013BreastDX-01-0014BreastDX-01-0015BreastDX-01-0016BreastDX-01-0017BreastDX-01-0018BreastDX-01-0019BreastDX-01-0020BreastDX-01-0021BreastDX-01-0022BreastDX-01-0023BreastDX-01-0024BreastDX-01-0025BreastDX-01-0026BreastDX-01-0028BreastDX-01-0029BreastDX-01-0030BreastDX-01-0031BreastDX-01-0032BreastDX-01-0033BreastDX-01-0034BreastDX-01-0035BreastDX-01-0036BreastDX-01-0037BreastDX-01-0038BreastDX-01-0039BreastDX-01-0040BreastDX-01-0041BreastDX-01-0046BreastDX-01-0065BreastDX-01-0066BreastDX-01-0067BreastDX-01-0068BreastDX-01-0069BreastDX-01-0070BreastDX-01-0071BreastDX-01-0072BreastDX-01-0073BreastDX-01-0074
Backgroundhistory of left breast cancer (invasive ductal cancer), status post left partial mastectomy known left breast CA with indeterminate microcalcification clusters in right breastearly 40s with left breast cancer. LMP unknownhistory of left breast cancer treated with lumpectomy and radiation therapyhistory of the left breast cancer and suspicious cluster of calcifications in the upper-outer quadrant of the right breast. 40s-year-old with newly engorged left nipple age: 50s with history of right breast DCIS and new left breast cancer, status post recent breast conserving therapy with left lumpectomy, and status post right lumpectomy and radiation therapy last year. 70s y.o.with left breast cancer (biopsy proven infiltrating ductal carcinoma) and axillary metastases50s y. o. with history of right breast cancer s/p BCT now with newly diagnosed left breast cancer. LMP unknownlate 20's y.o. with bx-proven CA50s y.o. with recent diagnosed left breast CAhistory of right mastectomy for cancer presents for her first 6 month follow up for calcifications in her left breast and a left breast nodule. late 50's y.o.left nipple discharge and suspicious right breast mass
PathologyDxbenign fibrosisinfiltrat lobularInvasive ductal CAbenign fibrosisinfiltrating ductal CAbenign fibroadenomabenign fibrosisinvasive intraductalductal CA in situbenigninvasive ductal CAstromal hyperplasia no CAinvasive ductal CAbenign fibroadenomaductal CA in situinvasive lobularinvasive ductalducta CA in situINVASIVE DUCTAL CARCINOMA, MODIFIED SCARFF-BLOOM-RICHARDSON GRADE-I/III. A LESS THAN 5% INTRADUCTAL CARCINOMA COMPONENT, NUCLEAR GRADE-II/III, IS ALSO PRESENT.benign fibrocystDuctal carcinoma in-situ , solid type, nuclear grade III/III.intraductal CAbenignbenignductal CA in situinvasive intraductal CAinvasive intraductal CAinvasive ductal CAINVASIVE LOBULAR CARCINOMA. SIZE OF INVASIVE COMPONENT: 4x4x2cmINVASIVE DUCTAL CARCINOMA MODIFIED SCARFF-BLOOM-RICHARDSON GRADE: III/III. NO IN SITU CARCINOMA PRESENTINVASIVE DUCTAL CARCINOMAInvasive ductal carcinoma, modified Scarff-Bloom-Richardson grade II/III. No intraductal carcinoma component seen.Invasive Lobular Carcinomaspecimen: INVASIVE CARCINOMA. Lymph nodes reactive but neg
Which breastLRLLRLLLRRRLRRRLLLLLRLLRLLLLLRRLLUR
ERpospospos (strongly)posposnegposposweaknegpos (strong)posnegnegpospos (strong)pos (strong)pos (weak)pos (strong)negpos (strong)
PRneg (stain moderate)pos (weak)pos (weak)posposnegposposweaknegpos (strong)negnegpospospos (strong)pos (strong)pos (weak)pos (strong)negpos (strong)
HER2negnegmoderate by FISHnegnegnegposnegnegpospos posposnegpospos negnegneg (weak)negpos (2+)
E-Cadherinnegpospos
Ki67high prolifintermed prolifhigh prolifhigh prolifhigh proliflow prolifhigh prolifintermed proliflow prolifhigh prolifintermed prolifpos (high prolif rate)pos (high prolif rate)pos (strong)pos hi prolif (49% nucs)intermed prolif rate
Oncotype score812132658182120381512
Oncotype risk8%9%17%34%11%14%13%26%9%8%
Age decade4050404060504040604040507050402050505040
Path reportNotesre-bx single 1cm residual CA focusre-bx 6/21/10 was scar tissue from RT rxRIGHT BREAST MASS: INFILTRATING DUCTAL CARCINOMA, MODIFIED SCARFF-BLOOM-RICHARDSON GRADE-II/III. A 5% INTRADUCTAL CARCINOMA COMPONENT, COMEDO TYPE, NUCLEAR GRADE III/III, IS ALSO PRESENT.re-bx 2/3/11 was no residual tumorre-bx 2/3/09 at calcific shows no residual tumormastectomy 1/2/09 show invasive ductal with axillary metsmastectomyRIGHT BREAST CALCIFICATION WITH NEEDLE LOCATION: FIBROADENOMA (1.9CM). REMAINING BREAST TISSUE WITH ADENOSIS, FOCAL FIBROADENOMATOUS CHANGES, APOCRINE METAPLASIA, FIBROCYSTIC CHANGES, SMALL INTRADUCTAL PAPILLOMAS, AND USUAL TYPE DUCTAL HYPERPLASIA. MICROCALCIFICATIONS ASSOCIATED WITH BENIGN BREAST TISSUE ARE IDENTIFIED. NO IN-SITU OR INVASIVE CARCINOMA.post surg path 12/30/10 showed only scar Invasive Lobular Carcinoma, S/P Neoadjuvant Therapy Size of invasive component: 2.5X2X2cm (largest focus) Tumor focality: Multiple foci of invasion Number of lymph nodes with macrometastases (>0.2 cm): 2 Size of largest metastatic deposit: 1.3cm Extranodal extension: PresentLeft breast: INVASIVE DUCTAL CARCINOMA, MODIFIED SCARFF-BLOOM-RICHARDSON GRADE-III/III.mastectomy; INVASIVE DUCTAL CARCINOMA, MODIFIED SCARFF-BLOOM-RICHARDSON GRADE-I/III. A LESS THAN 5% INTRADUCTAL CARCINOMA COMPONENT, NUCLEAR GRADE-II/III, IS ALSO PRESENT.Ductal carcinoma in-situ , solid type, nuclear grade III/III.Ductal carcinoma in-situRIGHT BREAST MASS: BENIGN BREAST TISSUE WITH SCLEROSING ADENOSIS, STROMAL FIBROSIS AND FIBROCYSTIC CHANGE. MICROCALCIFICATIONS PRESENT ASSOCIATED WITH BENIGN DUCTS. NO IN-SITU OR INVASIVE CARCINOMA.no path reportINVASIVE LOBULAR CARCINOMA. SIZE OF INVASIVE COMPONENT: 4x4x2cm HISTOLOGIC MODIFIED SCARF BLOOM RICHARDSON GRADE: I/III LESS THAN 5% OF DUCTAL AND LOBULAR CARCINOMA IN-SITU PRESENT. PERINEURAL INVASION IS PRESENT. MARGINS ARE NEGATIVE FOR CARCINOMA. INVASIVE LOBULAR CARCINOMA. SIZE OF INVASIVE COMPONENT: 4x4x2cm HISTOLOGIC MODIFIED SCARF BLOOM RICHARDSON GRADE: I/III LESS THAN 5% OF DUCTAL AND LOBULAR CARCINOMA IN-SITU PRESENT. PERINEURAL INVASION IS PRESENT. MARGINS ARE NEGATIVE FOR CARCINOMA. history of bilateral breast cancer, status post left lumpectomy INFILTRATING DUCTAL CARCINOMA, MODIFIED SCARFF-BLOOM-RICHARDSON GRADE-II/III. NO INTRADUCTAL CARCINOMA COMPONENT RIGHT BREAST AND AXILLARY CONTENTS HISTOLOGIC TYPE: INVASIVE DUCTAL CARCINOMA. SIZE OF INVASIVE COMPONENT: TWO FOCI, 1.3cm AND 1.9cm IN GREATEST DIMENSION RESPECTIVELY HISTOLOGIC MODIFIED SCARF BLOOM RICHARDSON GRADE: II/III EXTENSIVE INTRADUCTAL CARCINOMA (EIC): ABSENT MICROCALCIFICATIONS:PRESENT IN BOTH TUMOR AND NONNEOPLASTIC TISSUE SKIN/DERMAL LYMPHATICS INVASION: ABSENT No regional lymph node metastasis histologically Invasive ductal carcinoma, modified Scarff-Bloom-Richardson grade II/III. No intraductal carcinoma component seen.Invasive Lobular Carcinoma. Size of Invasive component: 0.6x0.5cm The tumor exhibits extensive mucinous features, however high nuclear grade is not a characteristic finding in cases of mucinous carcinoma, and therefore, the tumor is best classified as invasive ductal carcinoma with mucinous features. specimen is serially sectioned revealing a mass along the localization wire measuring 2.1 x 1 x 1 cm. The adjacent area is hemorrhagic and firm.. INVASIVE DUCTAL CARCINOMA, MODIFIED SCARFF-BLOOM-RICHARDSON GRADE 3 OF 3. Her-2/neu FISH Result Ratio of Her-2neu/ Chromosome 17 signals Amplification Present > 2.2 Borderline 1.8 - 2.2 Unamplified (negative) < 1.8
MRI reportWhich breast?RLLRRLRLRLA 10% INTRADUCTAL CARCINOMA COMPONENT, NUCLEAR GRADE 3 OF 3, IS ALSO PRESENT.
BIRAD65266636252664B665
ImpressionRIGHT BREAST: There is moderate background enhancement. Within the lower, central right breast at 6-7:00 position is an irregularly marginated, bilobed, enhancing mass which measures 2.1 x 2.0 x 4.6 cm. There is a biopsy clip along within the center and slightly medial portion of the mass. The mass demonstrates rapid and persistent enhancement. No areas of architectural distortion are seen within the right breast. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. IMPRESSION: 1) 4.5 cm bilobed, irregularly marginated, enhancing mass in the lower, central right breast with marking clip located centrally within the mass consistent with recent biopsy proven lobular carcinoma. 2) No evidence of right axillary lymphadenopathy. 3) No evidence of malignancy in the left breast.RIGHT BREAST: There is moderate background enhancement. Within the lateral right breast extending from the upper to the lower quadrant is a multilobulated, spiculated, enhancing mass. The mass spans 6.2 cm in cranio-caudal dimension, 3.7 cm in anterior - posterior dimension and 2.5 cm in axial dimension. The mass abuts the chest wall. There is a single break in the fat plane between the mass and the chest wall which measures approximately 2mm which is concerning involvement of the pectoral muscle. In the 11:00 position centrally in the mid left breast is a 0.6 cm reniform shaped mass with a Type I enhancement kinetic. In the right axilla are several enlarged, enhancing lymph nodes with loss of the normal reniform shape measuring up to 1.9 x 1.1cm. IMPRESSION: 1. Highly suspicious multilobulated, spiculated enhancing mass spanning across the upper and lower right lateral quadrants, measuring 6.2 x 3.7 x 2.5 cm. The mass abuts chest wall and beginning involvement of the pectoral muscle is likely. 2. Several enlarged right axillary lymph nodes concerning for metastatic involvement. 3. Small probable lymph node in the 11:00 position of the right breast measuring 0.5 cm. 4. No evidence of malignancy in the left breast.scattered bilateral cysts and fibroadenomas Expected post-treatment findings in the left breast with a seroma at the surgical site. No suspicious enhancement in the lumpectomy bed nor in the remainder of the left breast. RIGHT BREAST: There is moderate background enhancement. There is a well circumscribed, macro-lobulated T2 hyperintense lesion in the lateral right breast with T2 hypointense septations. This is best seen on series 301 image 41, located at 10:00. Overall it measures 1.9 x 1.7 x 1.7 cm with a total volume of 2.7 cc and demonstrates predominately progressive enhancement with a few scattered areas of plateau type enhancement. This is consistent with a fibroadenoma. There are other smaller lesions scattered throughout both breasts, similar in both in morphology and enhancement characteristics. They are more numerous on the right than on the left and measure up to 1.0 cm in size. These are most likely multiple fibroadenomata. Right breast is otherwise notable for multiple small circumscribed T2-hyperintense nonenhancing lesions consistent with simple cysts. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the right breast. Specifically, there is no MRI correlate for the suspicious hypoechoic lesion seen on prior ultrasound. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. LEFT BREAST: There is moderate background enhancement. As detailed above, there are multiple well-defined T2 hyperintense lesions with predominantly progressive enhancement most consistent with fibroadenomata. Additionally, small T2 hyperintense nonenhancing lesions are seen consistent with simple cysts, the largest measuring up to 7 mm in the central left breast. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the left breast. There is no skin thickening, nipple inversion, or left axillary lymphadenopathy present. Post lumpectomy changes in the right breast. Residual cluster of indeterminate calcifications in the upper-outer quadrant of the right breast. Right Breast: There is moderate background enhancement. The first mass in the upper, outer, posterior quadrant now measures 1.8 x 1.2 cm (previously 2.1 x 1.7 cm) and the second mass which is anterior and medial to the first now measures 1.4 x 0.7 (previously 1.4 x 1.0 cm). The enlarged intramammary lymph node in the upper, outer posterior quadrant has also slightly decreased in size now measuring 0.8 x 0.9 cm (previously 1.1 x 1.6 cm). The right axillary lymph node has decreased in size and now measures 0.8 x 0.8 cm (previously 1.2 x 0.9 cm). There is no skin thickening or nipple inversion present. non-contrast exam. LEFT BREAST: The known left upper outer breast mass measures on the noncontrast enhanced images approximately 5.2 x 3.1 x 2.5 cm. There isa thin fat line between posterior aspect of the mass and pectoral muscle. The distance between mass and pectoral muscle is less than 2 mm. In the left axilla there is the known malignant lymph node seen measuring 2.1 x 1.7 cm. RIGHT BREAST: In the right upper inner breast there is a T2 hypointense rounded nodule seen measuring 5 x 6 mm. This is possible the correlate to the mammographic nodule with microcalcifications which could not to be stereotactically biopsied due to the superficial location. On MR the distance from this nodule to the skin is 8 mm. A second nodule, strongly T2 hypointense in the right central medial posterior breast is most likely the correlate of the mammographic nodule with coarse benign appearing calcifications.. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. 1) Known 5.2 x 3.1 x 2.5 cm left upper outer breast mass with proximity to the pectoral muscle and malignant left axillary 2 cm lymph node. 2) 5 x 6 mm right upper inner breast nodule likely the correlate of themammographic nodule with associated microcalcifications, The breasts demonstrate moderate background enhancement. Three masses are seen within the lateral mid left breast. From anterior to posterior, they are as follows: At 4:00, in the anterior depth, there is a 1.1 x 0.4 x 1.4 cm oval nodule. At 4:00, in the middle depth, there is a 2.0 x 1.2 x 1.6 cm oval mass. At 3:00 in the posterior depth, there is a 1.2 x 1.1 x 1.2 cm round mass, which likely corresponds to the lesion which was biopsied. All 3 masses demonstrated a mixture of continuous, plateau, and washout enhancement kinetics with rapid initial uptake of contrast. The total volume of tissue occupied by the masses measures 6 cm AP x 3 cm transverse x 3 cm craniocaudal. The most posterior mass located 1.5 cm from the pectoralis muscle. There is no evidence of chest wall invasion. No enlarged lymph nodes are identified. No skin thickening or nipple retraction is seen. No suspicious masses or suspicious foci of contrast enhancement are seen within the right breast. IMPRESSION: 1. Three masses within the lateral left breast. The 1 cm mass at 3:00 in the posterior depth most likely corresponds to the biopsy-proven breast cancer. The 2 other masses demonstrates similar enhancement kinetics and are highly suspicious for malignancy. 2. No MR evidence of invasive malignancy within the right breast. 1) 1 cm mass at the 11:00 position in the left breast with suspicious enhancment adjacent to a surgical clip at site of biopsy proven invasive ductal carcinoma. 2) Second surgical clip in the upper, inner quadrant of the right breast at the area of a second site of invasive ductal carcinoma. There is only a minimal residual amount of progressive enhancement surrounding the clip. 3) No suspicious appearing lymph nodes in either axilla. 4) No evidence of malignancy in the right breast.1) Stable right breast focus of probably benign enhancement. 2) Stable left breast post treatment changes. No evidence of new or recurrent malignancy within the left breast. 1) Large segmental region of non-masslike suspicious enhancement with kinetics containing type III curves in the region of known biopsy-proven DCIS in the left breast between 2-6 o'clock. 2) 2 small foci of suspicious enhancement in the right breast in the lower outer right breast, one of which is linear, which have components of type III curves in a similar manner to the larger focus of biopsy-proven DCIS on the left. No MR evidence of invasive malignancy. No MR abnormality to correlate with the cluster of calcifications in the upper-outer quadrant of the right breast. MR sensitivity for in situ malignancy is less than that for invasive disease. Postsurgical and postradiation changes within the left breast.status post left breast lumpectomy and radiation therapy one year ago; annual followup; no complaints. Report: scattered fibroglandular densities. In the upper, outer quadrant of the left breast is an area of trabecular thickening and increased density as well as focal skin retraction and skin thickening presumably from post treatment changes. These are unchanged from the prior exam. Otherwise, no suspicious dominant or spiculated masses, suspicious clustered microcalcifications or areas of unexplained architectural distortion are seen in either breast. LEFT BREAST: There is moderate background enhancement. In the leftcentral slightly lateral breast mid depth, 2.4 cm from the nipple and 1.7 cm from the skin there is a 3.4 x 1.5 x 2.3 cm suspiciously enhancing mass seen (volume 2.8 cc), irregularly shaped and spiculated with centrally rapid wash in and washout pattern (Type 3). Posterior tothis dominant lesion there is a second 1.3 x 0.5 x 0.96 cm suspiciously enhancing (Type 3) focus of enhancement seen (5.6 cm from the nipple and 1.9 cm from the skin). Anterior to the dominant lesion there are small areas of suspicious enhancement seen up to 0.9 cm from the nipple. The total anterior posterior extension of the enhancing masses and foci is 5.4 cm in linear order towards the nipple (0.9 cm distance from nipple) and the maximal lateral is 2.5 cm. There is nipple inversion. There is no skin thickening, or left axillary lymphadenopathy present. Benign up to 8 mm simple cysts. RIGHT BREAST: There is moderate background enhancement. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the right breast. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. Benign simple up to 12 mm cysts. IMPRESSION: 1) 3.5 cm suspicious mass in the left central breast. In addition second 1.3 cm focus of suspicious enhancement posterior to the dominant lesion, as detailed above. Total anterior posterior extension of enhancing mass smaller foci is 5.4 cm towards the nipple (9 mm) in linear configuration - and maximal lateral extension is 2.5 cm (significant images and detailed portfolio with post processed images are saved on PACS for review; raw images: series 705 slice location 84-100).) 2) Left nipple inversion. 3) No axillary lymphadenopathy, no evidence for pectoral muscle involvement. 4) No evidence of contralateral disease. LEFT BREAST: There is moderate background enhancement. There is a large 8.0 x 6.5 x 5.5 cm seroma seen in the left upper central and upper inner breast within the surgical bed, without suspicious morphologic imaging features or suspicious kinetics on the dynamic series. There is expected peripheral hypervascularity seen in and around the surgical bed. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the left breast.There is a 1.4 x 0.9 x 1.3 cm (0.83 cc) left axillary kidney shaped lymphnode seen (image 67 series 40), with mixed kinetics, preserved fatty hilum - suggestive for reactive lymphnode - and an expected finding after recent surgery. There is no skin thickening, or nipple inversion present. RIGHT BREAST: There is moderate background enhancement. There are several surgical clips seen in the right upper central and upper outer breast, with expected post surgical mild architectural distortion and scar tissue. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the right breast. There is mild skin thickening - post radiation. No nipple inversion, or right axillary lymphadenopathy present. IMPRESSION: 1) No MRI evidence for residual malignancy in either breast. 2) Expected 8 cm left breast post surgical seroma. 3) Expected right breast post treatment changes. 4) Reactive left axillary lymphnode - post surgical. LEFT BREAST: There is minimal background enhancement. A mass in the left upper outer posterior breast has irregular margins with peripheral irregular enhancement and has associated mild architectural distortion. It is located at 2 o'clock , approximately 10 cm from the nipple and 2.2 cm from the chest wall. The mass demonstrates rapid intense early contrast enhancement with washout. It measures approximately 2.8 x 2.3 x 2.4 cm (Series 705, Slice 84). A biopsy clip is noted in the lateral portion of the mass. Two satellite foci of enhancement are noted adjacent to the known cancer with washout kinetics. One measures approximately 0.6 x 0.4 x 0.7 cm (Series 705, Slice 66), and is located approximately 1 cm inferior to the large mass in the left upper outer breast at 2 o'clock, approximately 10 cm from the nipple. The other focus of enhancement measures approximately 0.3 x 0.2 x 0.8 cm and is located approximately 6 mm posterior to the large mass (Series 705, Slice 76) at approximately 1 0'clock, 12.5 cm from the nipple. There are enlarged left axillary lymph nodes measuring up to 3.1 x 1.5 cm (Series 301, Slice 118). A 1.2 x 0.6 cm left subpectoral lymph node is also noted (Series 301, Slice 146), between the pectoralis minor and chest wall, just below the left subclavian vessels. No skin thickening or nipple inversion. RIGHT BREAST: There is minimal background enhancement. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the right breast. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. IMPRESSION: 1) Approximately 2.8 cm mass in the left upper outer breast, biopsy proven cancer, with two adjacent satellite foci measuring up to 0.8 cm. 2) Enlarged metastatic left axillary lymph nodes and a left subpectoral - subclavian lymph node. 3) No evidence of malignancy in the right breast LEFT BREAST: There is moderate background enhancement. Within the 10:00 position of the mid left breast is an irregularly marginated mass measuring 1.3 x 0.9 x 1.4 cm. The mass has Type III enhancement kinetics with rapid enhancement and rapid washout. No other areas of suspicious enhancement are seen. There is no skin thickening, nipple inversion, or left axillary lymphadenopathy present. RIGHT BREAST: There is moderate background enhancement. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the right breast. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. IMPRESSION: 1. 1.4 cm enhancing mass at the 10:00 position of the central left breast consistent with biopsy proven breast cancer. No satellite lesions are detected. 2. No evidence of abnormal lymph nodes in either axilla. 3. No evidence of malignancy in the right breast. LEFT BREAST: There is moderate background enhancement. In the central to 6:00 location approximately 2 cm anterior to the chest wall, is an oval shaped mass measuring 10 mm ( SE 701 SL 57.9). The enhancement dynamics is progressive persistent. There is no signal on the T2 weighted images of this mass. No masses are noted in any other region of the breast. RIGHT BREAST: There is moderate background enhancement. 1. There is extensive non-mass, heterogeneous enhancement in the upper inner quadrant extending for 7 cm (AP) and 5 cm (SI) dimensions (SE 701 SL 81). 2. There is a spiculated enhancing mass in the 12:00 location mid-breast that is at the lateral extent of the non-mass enhancement. This mass measures 12 x 12 mm (SE 701, SL 87; SE 605, SL 102). A signal void from a biopsy clip is at the lateral margin of this mass. 3. In this same plane in the 12:00 location but posteriorly near the chest wall is a large area of non-mass, heterogeneous enhancement. A signal void at the most inferior edge of this enhancementis noted. 4. In the upper outer quadrant, there is another large spiculated mass with surrounding parenchymal enhancement that measures approximately 32 x 32 mm (SE 701 SL 100.5; SE 605 SL 112). 5. There is non-specific, non-mass enhancement extending into the inferior breast centrally- to 6:00 location near the chest wall. 7. Lymph nodes are very posterior in location, and are therefore incompletely visualized. IMPRESSION: 1) Findings most consistent with multicentric malignancy involving all four quadrants of the RIGHT breast , as documented by the two core biopsies. Cannot rule out lymphadenopathy, which may be non-specific since this study was performed post-core biopsies. 2) Suspicious solitary 1 cm mass in the LEFT in spite of kinetics since it is a solitary finding. In spite of the T2 findings, this may represent a fibroadenoma due to its morphology, but malignancy cannot be ruled out. Numerous scattered bilateral simple cysts are seen, some of which are clustered, consistent with fibrocystic changes. LEFT BREAST: There is extreme background enhancement. There is an enhancing nodular lesion which measures 1.9 x 1.2 x 2 cm within the centro-lateral right breast (series 401-image 37, dynamic post-contrast slice 72) with a malignant enhancing pattern. This lesion correlates with patient's biopsy-proven cancer. Additionally, approximately 2.5 cm posterior and 1 cm inferior to the patient's known cancer, there is another nodular enhancing lesion which measures up to 1.4 x 0.4 x 1.3 cm. This lesion shows an indeterminate mixed pattern (part of if might be vascular) enhancement, however it is highly suspicious for satellite malignant lesion given its geographic-nodular morphology. No evidence of pectoral muscle infiltration. Normal benign-appearing right axillary lymph nodes are seen with no suspicious enlargement. There is no skin thickening, nipple inversion, or left axillary lymphadenopathy present. Incidental note also made of expected post biopsy findings just anterior to the known malignant lesion. RIGHT BREAST: There is extreme background enhancement. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the right breast. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. IMPRESSION: 1) Suspicious enhancing lesion within the centro-lateral right breast, consistent with patient's known biopsy-proven breast cancer, as detailed above. 2) Additional suspicious nodular area of mixed enhancement a possible second focus of cancer, posterior to the known malignant lesion, as described above. The indeterminate pattern of enhancement suggests the possibility of this representing a vascular structure. However, its nodular geographic morphology makes it highly suspicious for a malignant satellite lesion. 3) Fibrocystic changes within bilateral breasts. LEFT BREAST: There is minimal background enhancement. In the left upper outer breast very superficial there is a biopsy clip seen approx 1-2 o'clock mid-depth. Surrounding the susceptibility artefact of the clip, there no remnant mass or suspicious enhancement seen. Exactly 1.5 cm inferior and 1.0 cm medial to the clip there is a linear area of indeterminate enhancement seen measuring 0.7 x 0.4 cm; this might be vascular, however it is recommended to include this area in the surgical plan. Otherwise no suspicious enhancement, masses, or areas of architectural distortion seen within the left breast. There is no skin thickening, nipple inversion, or left axillary lymphadenopathy present. RIGHT BREAST: There is minimal background enhancement. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the right breast. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. IMPRESSION: 1) No remnant mass seen in the area of the artifact caused by the biopsy clip, marking the area of the known cancer in the upper outer very superficial breast, mid depth, at approx. 1-2 o'clock. 2) Exactly 1.5 cm inferior and 1 cm medial to the biopsy clip there is an linear area of indeterminate enhancement seen, measuring 7 x 4 mm, which is possibly vascular, however should be included in the surgical plan, to rule out DCIS. Otherwise, no additional suspicious area in the left breast. No left lymphadenopathy. 3) Unremarkable right breast and axilla. No evidence of malignancy of the contralateral right breast. No right axillary lymphadenopathy .Increasing pleiomorphic calcifications in the upper, outer quadrant left breast,Highly suggestive of malignancy LEFT BREAST: There is minimal background enhancement. No foci of suspicious enhancement, masses, or areas of architectural distortion seen within the left breast. There is no skin thickening, nipple inversion, or left axillary lymphadenopathy present. No MRI correlate or explanation for the left nipple discharge. RIGHT BREAST: There is minimal background enhancement. At 10 o'clock mid-depth, there is a suspiciously enhancing (Mixed with Type 2 and 3), irregular, spiculated mass seen, measuring 1.9 x 1.7 x 1.8 cm. This is highly suspicious for malignancy. (series 601 and 401 slice location 68-88; images are annotated on PACS, tumor is circled). No additional foci of suspicious enhancement or areas of architectural distortion seen within the right breast. There is no skin thickening, nipple inversion, or right axillary lymphadenopathy present. IMPRESSION: 1) Highly suspicious 2 cm right breast mass at 10 o'clock - as seen on Ultrasound. No MRI evidence of satellite lesions or lymphadenopathy. 2) No evidence of malignancy of the left breast. No MRI correlate for the left nipple discharge. Final disposition of the left nipple discharge has to be based on clinical assessment. 3) Incidental note is made of displaced Colon portions into the right hemithorax. Further imaging (dedicated CT or MRI) needed for complete assessment, if this in not clinically known already. Diagnostic mammogram: The right breast is predominantly fatty. As seen on the prior screening mammogram, there is a circumscribed, round 9 mm nodule at approximately 8 o'clock, with a punctate calcification. Otherwise, no suspicious dominant or spiculated masses, suspicious clustered microcalcifications or areas of unexplained architectural distortion are seen.