PMC4891407_01
A 64-year-old asymptomatic female presents for screening and subsequent diagnostic mammography: 1A) Left mediolateral oblique (MLO) demonstrates a mass in the upper breast (large arrow) while the smaller arrows denote an artery for anatomic reference, 1B) Craniocaudal (CC) view shows that the mass is in the inner left breast (solid arrow):dust artifact is noted medial to this finding (open arrow) [powerpoint slide]
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This examination revealed a mass in the inner left breast (Figure 1a and b). Diagnostic views confirmed this finding (Figure 1c) and an MRI was recommended for further evaluation.
Four sequential frames with 2 mm slice thickness from three dimensional fat suppressed T1-weighted gradient recalled echo sequence (from just medial to the nipple proceeding medially) obtained approximately 9 minutes after Gd-DTPA contrast injection demonstrate a spiculated mass in the left upper slightly inner breast (arrow). [powerpoint slide]
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A dynamic contrast-enhanced MRI examination in February 2002 revealed a suspicious 9 mm mass in the upper inner left breast (Figure 2 a-d) corresponding to the mammographic finding and demonstrating rapid uptake of gadolinium with washout in the delayed phase.
Six weeks after the initial breast MRI, a repeat study for the purpose of needle localization was performed. Four sequential frames using the same slice thickness in the same location from a T1-fat-suppressed imaging obtained two minutes after contrast injection demonstrate significantly diminished size and enhancement of the mass (arrow). The breast anatomy appears slightly different due to light compression placed during the needle localization procedure.[powerpoint slide]
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Repeat MRI examination with light breast compression but an otherwise identical imaging protocol showed that the MRI abnormality had decreased in size to 4 mm (Figure 3 a-d) and the enhancement was less marked.
Six months after the initial mammogram: 4A) left MLO (smaller arrows denote an artery for anatomic reference), 4B) CC, and 4C) photographic magnification in the CC projection demonstrate that the mass has decreased in size (large arrow). [powerpoint slide]
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This mammogram demonstrated the mass had continued to decrease in size, measuring 3 mm (Figure 4 a-c).
One year after the initial mammogram: 5A) left MLO (smaller arrows denote an artery for anatomic reference), 5B) CC, and 5C) photographic magnification in the CC projection (arrow denotes the area of interest) demonstrate that the mass has disappeared. [powerpoint slide]
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The patient was advised to resume a screening schedule of mammography and in December of 2002 the mass had resolved completely (Figure 5 a-c).
Two years after the initial mammogram, 6A) left MLO (smaller arrows denote an artery for anatomic reference), 6B) CC, and 6C) photographic magnification in the CC projection demonstrate that the mass has recurred (large arrow). [powerpoint slide]
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A 10 mm mass was observed on screening mammography in December of 2003, and confirmed on diagnostic mammography in January of 2004 in the exact location of the previously identified finding, in the upper inner left breast (Figure 6 a-c).
Ultrasound images of the left upper inner breast (all in the transverse plane) demonstrate: 7A) a 10 cm hypoechoic mass with a thick hyperechoic rim (arrow), 7B) ultrasound guided biopsy of the mass (arrow), and 7C) the mass (large arrow) following placement of a clip (small arrow) just adjacent to the mass. [powerpoint slide]
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Ultrasound revealed a corresponding 10 mm hypoechoic mass with a thick hyperechoic rim in the left upper inner left breast (Figure 7a). An ultrasound-guided core biopsy (Figure 7b) and clip placement (Figure 7c) were performed.
Following ultrasound guided core biopsy; 8A) left MLO (smaller arrows denote an artery for anatomic reference), 8B) CC, and 8C) photographic magnification in the CC projection demonstrate the mass (large solid arrow) and a radioopaque marking clip (large open arrow) placed in the anterior lateral aspect of the tumor. [powerpoint slide]
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Post-procedure mammography showed the clip to be located in the anterior aspect of the mass (Figure 8 a-c).