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Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast.

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History

Nulliparous patient, taking hormone replacement treatment.


Findings

Masses with stellar outlines, highly visible on the tomosynthesis image, situated in the left upper medial quadrant, measuring 7-8 mm in diameter on the mammogram, classified ACR 5.
A second lesion, more difficult to identify, in the form of an architectural distortion, situated in the left upper lateral quadrant, positioned less high than the medial lesion, more visible with tomosynthesis than with the mammogram, high ACR 4.
Both lesions were identified and biopsied under ultrasound:
- upper medial mass in the left breast: SBR grade II infiltrating ductal carcinoma.
- left upper lateral mass: ductal carcinoma in situ of intermediate grade, associated with a site of infiltrating ductal carcinoma measuring 2 mm


Diagnosis

Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast.


Key points

Here, the second cancerous nodule had not been diagnosed before the patient was referred to us. Its presence is effectively very difficult to identify on the standard images, because of the density of the gland. On the other hand, it is clearly visible with tomosynthesis.
With MRI, the left upper medial lesion is clearly visible. On the other hand, the lateral lesion is masked by diffuse matrix enhancement.



Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast. LCC

LCC

Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast. LML

LML

Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast. LCC Tomosynthesis

LCC Tomosynthesis

Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast. LML Tomosynthesis

LML Tomosynthesis

Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast. Echo

Echo

Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast. Echo

Echo

Bicentric tumour: SBR grade II infiltrating ductal carcinoma of the upper medial quadrant and ductal carcinoma in situ with an infiltrating component in the upper lateral quandrant of the left breast. LML Acquisition Tomo

LML Acquisition Tomo

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