History of poorly differentiated invasive ductal carcinoma of the left breast. Patient received neoadjuvant chemotherapy. Palpable mass in the left breast has recently increased in size. Please evaluate. Note is made that the patient is on Lovenox with marked bruising of the abdomen. History of breast cancer in 3 maternal aunts and two maternal cousins. LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: Three standard views, an additional MLO view and 2 spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A triangular marker was placed on the skin at the site of palpable mass. Near the 6 o'clock position of the left breast, a 4.5 x 3.2 x 5.5 cm lobulated mass is present containing a percutaneous clip and malignant calcifications. On the most recent mammogram, the mass measured 2.4 x 2.1 x 2.9 cm. On the mammogram of 8/6/2014, the mass measured 4.3 x 4.0 x 4.7 cm. Arterial calcifications are present. The left axilla is obscured by a cardiac generator device.LEFT BREAST ULTRASOUND: On physical examination, the patient has a 4 cm palpable mass at the 6 o'clock position of the left breast. The skin overlying the mass is ecchymotic. A focused left breast ultrasound was performed. At the 6 o'clock position of the left breast, 4 cm from the nipple, a 3.2 x 2.2 x 3.8 cm lobulated hypoechoic mass is present containing in Hydromark clip. Previous measurements on 10/28/2014 were 2.4 x 1.9 x 2.6 cm. On 8/6/2014 the measurements were 4.2 x 3.7 x 2.9 cm.
Interval increase in the size of biopsy proven carcinoma at the 6 o'clock position of the left breast. Given the history of Lovenox and overlying bruising, a portion of the size increase may be due to internal hematoma. Results were discussed with the patient and her daughter.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.