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Invasive lobular breast carcinoma

Case contributed by Garth Kruger
Diagnosis probable

Presentation

Palpable mass lesion. Patient has a frozen left shoulder.

Patient Data

Age: Adult
Gender: Female
mammography

Technically challenging study. The asymmetry against the chest wall medially is new compared with previous.

ultrasound

This is what the lesion above looks like on ultrasound. You can appreciate the two areas of density above are also seen on the ultrasound. The ultrasound image shows a vague solid appearing lesion with an acoustic shadow.

mammography

Another case of lobular carcinoma just to bring home the teaching point. The very subtle area of increased parenchymal density centrally post is a new finding compared with previous.

Case Discussion

Invasive lobular carcinomas are challenging lesions to detect. In large series of cancers, these are the lesions we are prone to miss as breast imagers. The reason is these lesions do not elicit the scirrhous response we usually expect to see with IDC. The lesions usually present without the surrounding spiculated margins we traditionally associate with an IDC. These lesions are subtle and are usually found as areas of parenchymal asymmetry. Comparison with previous imaging and a high index of suspicion will enable you to spot these lesions more frequently.

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