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27-year-old, Breast Mass

27-year-old, Breast Mass

  • 27-year-old female presented with right upper outer quadrant firm breast mass.
  • Figure 1. Both breasts CC and MLO views demonstrate widespread distribution of compact microcalcification clusters running from the nipple posteriorly, even over an entire upper outer quadrant of the right breast, accompanied by increased parenchymal density.
  • Figure 2. Figure 1. Both breasts CC and MLO views demonstrate widespread distribution of compact microcalcification clusters running from the nipple posteriorly, even over an entire upper outer quadrant of the right breast, accompanied by increased parenchymal density.
  • Figure 3. Ultrasound shows increased parenchymal echogenictiy and expanded lactigerous ducts by soft tissue growth containing echogenic foci of clustered microcalfication.
  • Figure 4A. Sagittal and coronal precontrast enhanced T2 FS MRI showing segmental area of abnormal high attenuation filling the UOQ.
  • Figure 4B. Sagittal and coronal precontrast enhanced T2 FS MRI showing segmental area of abnormal high attenuation filling the UOQ.
  • Figure 5. Homogeneous enhancement and washout kinetics (arrow) encompassing most of the upper outer quadrant.
  • Diagnosis: DCIS
  • Sagittal and coronal precontrast enhanced T2 FS MRI shows segmental area of abnormal high attenuation filling the UOQ, showing homogeneous enhancement and washout kinetics (arrows) encompassing most of upper outer quadrant.
  • Microcalcifications can be an early and only presenting sign of breast cancer.
  • In large screening programs, DCIS make up to 30% of malignancies diagnosed.
  • In the context of overdiagnosis, the low grade DCIS cases found on screening mammography are likely to cause a number of cases in which the diagnosis of breast malignancy has been made but could conceivably not have been fatal to the patient.

Case History: A 27-year-old female presented with right upper outer quadrant firm breast mass.

Comments

calcified fibroadenoma

mousa @

ca

ayman @

Plasmacellular mastitis

debora @

DCIS

Emanoil @

Plasmacellular mastitis

Giuliano @

This appears like a text book case and following Birads despite a young age she needs biopsy.

Leila @

low grade wide spread DCIS.

Kiyoshi @

cancer

yuanzhong @

Pray do let us know the punch line at some point. Not at all useful (the way it is presented) as a teaching case.

Julia @

What was the pathological diagnosis here? (Sorry, is this meant to be a teaching case?)

Julia @

In my government Sharkia in Egypt most of the populations farmers and not have enough education, so most of the cases come with large size masses, in many advanced fixed to the chest wall. Moreover lactating and pregnant malignant cases getting increasing in number for unexplained reasons

Doaa @

this case pathologically proved as DCI& IDC

Doaa @

Malignant. DCIS MOST LIKELY

peter @

As a director of a breast center and breast surgeon (since 1988) as usual the real question in this case is glossed over. Who cares what it is? The two important topics we should be discussing is management. Just core the thing and you know, but it sure looks like some form of cancer to me. But the trick comes if it was really tiny, would you watch it? Hope not. And the answer isn't repeated MRIs, its hard enough for me to get only one authorized and besides the measurable amount of gadolinium in San Francisco Bay has increased seven times and now in the fish.

But the real issue here isn't the diagnosis, it's is why in the hell was it allowed that this kid has such a large mass and nothing was done to get it sooner? How many times must it be said that breast cancer is a disease of women (mostly) and doesn't discriminate between ages. So when a young patient says she feels a strange thing in her breast don't blow it off. We as a nation need to decide how important women are and what we are going to do to make things better?Are we going to have centers early on so a 20 or 30 something can go for real help by people who take care of breast cancer and know about it and can implement changes like lifestyle epigenomics and diet when it can make a difference? Or are we going to maintain the 30 year old 'comprehensive breast centers' where really knowledgeable doctors are behind a metaphoric wall only to come in contact with the patient AFTER the diagnosis is made and they try an put Humpty Dumpty together again. GPs should not be saddled with the nuances of ferreting out tiny cancers, that should be our job surgeons and radiologists working together in a colleagial fashion. If the NCI is right, by 2030 breast cancer rates will double to 400,000 and if we don't do something different that will mean 80,000 deaths, mostly unnecessary. No offence here to my radiology colleagues, but do we continue to have radiologists sit in a dark room mostly never seeing the patient let alone examen the patient (some years ago Blue Shield issued a statement that said, 'it wasn't standard of care for a radiologist to examen a patient's breast'. Just another example of many where functionaries destroy our profession. Or do we join together become part of the team who know the outcomes of what we do? Or can we ever have a setup where breast surgeons and radiologist can work literally side by side and learn from each other to avoid unnecessary tests and save lives and preserve mind body and spirit (that part gets lost now with the emergence of 'Oncopastic Surgery'. Is aggressive Oncoplastic Surgery the answer we have for women after about 300 billion in research and clinical trials proving that aggressive surgery meaning mastectomy combines with CPM (collateral prophylactic mastectomy) doesn't make any difference? I think not. Perhaps at one of your next national meetings you should have a surgeon talk about how we could make things better everywhere or not. This whole thing needs to be reevaluated and then maybe we can talk about diagnosis on a mammogram. Sorry for the rant just needed to give my opinion since this is marginally still the USA, have a nice day.

Phil B

Phil @

sure you said the correct words all the world participating the criminal in the women wrights because there is no suitable places and qualified doctors to give their attention to the cancer breast. Evey day i saw advanced cases in young and old ages, the problem is growing i hope to fit this killer and keep all women in good health but how?. Here in Egypt advanced cases cant get any treatment most of the population are poor .

Doaa @

Unable to advance to next picture. This seems to be a continual problem with these case studies. It would be wonderful if it could be fixed.

Catherine @

Hi Catherine, what browser are you using? Also, how are you trying to advance the slides?

Liza @

Catherine: I've had the same problem. They can't seem to find a solution.

Herb Kaufman

herbert @

Is there a definitive Dx made here?

Harry @

cancer

william @

The discussion here is very misleading, This is a large cancer and the pt needs surgery.

V @

Lobular carcinoma

david @

Hamartoma

david @

jose cisneros

jose @

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