PMC6024341_01
Mammography. Craniocaudal and mediolateral oblique views of the right and the left breast demonstrate bilateral flame-shaped gynecomastia. Disseminated microcalcifications are present in both breasts (arrows). A suspicious lesion is not visible. The mammograms were categorized as BI-RADS 2 (benign findings, diffuse distributed calcifications).
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System (BI-RADS) lexicon as BI-RADS 2 (Figure 1). Subsequent targeted high-resolution ultrasound of the left breast raised suspicion for a lipoma (8 x 29 x 26 mm) without any sonographic explanation for bloody nipple discharge.
Ultrasound. Targeted high-resolution ultrasound of the left breast raised suspicion for a lipoma. Ultrasound findings of the left breast were categorized as BI-RADS 0 (further imaging is required).
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BI-RADS 0 (further imaging required) of the left breast and BI-RADS 1 of the right breast (Figure 2). Because of the equivocal findings in mammography and ultrasound, native as well as contrast-enhanced breast MRI was performed, using a 1.5T magnet.
MRI findings; native (T2-TSE-tra-4 mm) or contrast-enhanced (T1-fl3d-tra-dyn-2.5 mm). (a) Native MRI shows bilateral gynecomastia. (b) Contrast imaging of the right breast demonstrates an unsuspicious retroareolar small point-shaped contrast enhancement (arrow). (c) A suspicious retroareolar non-mass abnormality of segmental, linear and dendritic pattern is visible after contrast-enhanced imaging of the left breast (arrows). (d) An enlarged lymph node of the left axillary is shown after contrast enhancement (arrow). Axillary lymph nodes of the right side are unsuspicious. MRI findings were categorized as BI-RADS 4 of the left breast and BI-RADS 3 of the right breast.
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MRI findings of the right breast were categorized as BI-RADS 3 (small point-shaped contrast enhancement, probably benign, short interval follow-up suggested) (Figure 3).
Stereotactic guided biopsy of the left breast. Magnified specimen radiograph shows microcalcifications in core biopsies (arrows).
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Therefore, the patient underwent stereotactic guided biopsy of the left breast (Figure 4).
Histopathologic findings. (a) DCIS of papillary and cribriform pattern with microcalcifications (hematoxylin and eosin stain, 20x). (b) High-grade DCIS with big, pleomorphic cells and single-cell necrosis (hematoxylin and eosin stain, 400x).
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Microcalcifications were present (Figure 5).
MRI findings in the follow-up native (T2-TSE-tra-4 mm) or contrast-enhanced (T1-fl3d-tra-dyn-2.5 mm). (a) Native MRI in the follow-up (6 months later) shows a sclerosing lesion in the left breast which is consistent with the postoperative scar. (b) Previous point-shaped contrast enhancement of the right breast is still visible (arrow). (c) Previous left-sided lymph node enlargement is not present anymore in contrast-enhanced imaging.
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The imaging was bilaterally consistent with BI-RADS 2 (Figures 6 and 7).
Postoperative result. Patient 6 months later after simple mastectomy and sentinel lymph node excision of the left side were performed.
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The imaging was bilaterally consistent with BI-RADS 2 (Figures 6 and 7).