Developing breast density - history of previous treated breast cancer

Case contributed by Dr Garth Kruger

Presentation

This 65 year old patient had a left IDC (infiltrating ductal carcinoma) left breast 6 years before. The initial lesion was treated with lumpectomy and local radiation. She gets annual follow up mammograms.

Patient Data

Age: 65
Gender: Female

Post-surgical parenchymal distortion is seen. Otherwise unremarkable study.

Mammography

One year follow-up

A subtle focal density has now developed.

Rounded hypoechoic mass. 

Mammography

Six months later

The lesion looks much the same on the 6 month follow up mammogram. The reader suggests retruning to the regular follow up schedule i.e. repeat in 6 months.

Mammography

Six months later

It is now a full year after the lesion appeared and was dubbed BIRADS III. The lesion is larger on mammogram.

This is now a concerning lesion on ultrasound, the lesion is solid, hypoechoic and poorly circumscribed. The lesion is incompressible with the transducer.

Case Discussion

Biopsy confirms an infiltrating ductal carcinoma.

The teaching point is this: whatever biological trigger  (genetic or environmental) is present in the patient that allowed the initial cancer to grow, is still present after the therapy. Any lesion that appears subsequently should be seen with significant suspicion. There is likely no place for a Birads III diagnosis in a patient with a previous carcinoma.

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Case information

rID: 21556
Published: 31st Jan 2013
Last edited: 20th Nov 2018
System: Breast, Oncology
Inclusion in quiz mode: Excluded

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