PMC5220450_01
Left breast mammography, mediolateral oblique (a) and craniocaudal views (b). There is an architectural distortion in the upper quadrants of the left breast (white circle), not clearly seen in the craniocaudal view: Rocha A, Servicio de Radiologia, Hospital Povisa, Vigo, Spain.
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Mammography showed an architectural distortion in the upper quadrants of the left breast, only clearly seen in the mediolateral oblique view (Figure 1).
Left mediolateral oblique Tomosynthesis image section (a), with pathologic area close-up view (b). There was improved architectural distortion visualization further localized to the upper outer quadrant. Close-up view shows a small central mass with large spicules and focal retraction along the margin of the tissue: Rocha A, Servicio de Radiologia, Hospital Povisa, Vigo, Spain.
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DBT:routinely performed at the patient's hospital:localized the lesion to the upper outer quadrant and further characterized it as a small irregular mass with long spicules (Figure 2).
Ultrasound, transverse (a) and longitudinal (b) sections. A 10 mm solid nodule was shown, with irregular and ill-defined margins, taller rather than wider shaped, with a hyperechoic rim and posterior acoustic shadowing: Rocha A, Servicio de Radiologia, Hospital Povisa, Vigo, Spain.
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A targeted Ultrasound (US) showed a 10 mm solid nodule, with posterior acoustic shadowing (Figure 3).
Breast Magnetic Resonance T1-weighted images, after gadolinium administration and axial maximum intensity projection (MIP) reformations. In addition to the previously biopsied lesion in the upper outer quadrant, there was another nodule 35 mm apart, in the upper inner quadrant. It measured 8 mm and was also submitted to US-guided biopsy: Rocha A, Servicio de Radiologia, Hospital Povisa, Vigo, Spain.
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Imaging (MRI) was done to evaluate the local extension and showed, apart from this nodule, an additional one 8 mm in the upper inner quadrant, with the same imaging findings at MRI and US, and at a distance of 35 mm from the former (Figure 4). It was biopsied at second-look US, and the histologic diagnosis was also tubular carcinoma.