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e-CASES: SBR grade 2 infiltrating ductal carcinoma

History

Past family history of breast cancer in a first cousin.
No hormone replacement treatment.

Findings

A slightly retractile zone in the right upper lateral quadrant, which was not revealed with tomosynthesis, with a few dispersed, stable micro-calcifications.
At the level of the upper medial quadrant of the left breast, there was a well-defined rounded nodule, visible to about 75% of its perimeter with tomosynthesis, measuring 7 mm in diameter.
A second nodule in the lower lateral quadrant, partially calcified in “popcorn” form and stable, suggesting a fibroadenoma.
Ultrasound found it difficult to identify a 7 mm nodule in the left upper medial quadrant, as it was isoechoic in relation to the fatty tissue, and almost with posterior reinforcement.
In the lower lateral quadrant, a very adjacent nodule with irregular edges that seemed to correspond to the second mammogram image.
Given the atypical ultrasonic nature of the two nodules, an MRI was carried out, revealing:
- a nodule in the upper medial quadrant of early, fast and intense enhancement, generally regular
- a highly hypoT2 nodule in the lower lateral quadrant, not enhanced, suggesting an old fibroadenoma.
Biopsy under ultrasound of the nodule in the upper medial quadrant: SBR grade 2 infiltrating ductal carcinoma.


Diagnosis

SBR grade 2 infiltrating ductal carcinoma


Key points

Here, the tomosynthesis was falsely reassuring because of the regular aspect of the outline of the mass. It is important to search for the aspect of the edges: if the contour is partially masked, you should be suspicious and suspect a malignant lesion.



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