0:00

So 29 year old female presenting

0:03

with a palpable lump in the left breast for three

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weeks.

0:08

What is the first step? Oh,

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sorry, what is the first step?

0:17

So under age 30, you're going to want to start with an ultrasound and

0:22

So in this case, we see a mass right where she is feeling

0:25

the lump.

0:27

And then the next step.

0:29

What's the next best step?

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You want to do an ultrasound biopsy a mammogram

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and an ultrasound biopsy MRI or

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refer to a

0:40

breast surgeon?

0:48

All right, so I'm glad most people got this wrong. So

0:51

if you see something suspicious on ultrasound in

0:54

a patient that you know, that's under 30. You certainly

0:57

want to do an ultrasound by see but you're

1:00

also going to want to do a mammogram because really this could be

1:03

the tip of the iceberg. And in this case it was um,

1:06

so you're really going to assess both breasts. I

1:09

mean, you might see calcifications that you didn't realize we're there

1:12

that you couldn't appreciate

1:15

on ultrasound. So in this case you want to

1:18

do ultrasound and by a mammogram and ultrasound biopsy. There's

1:21

a little subtle skin thickening here and maybe a lesion

1:24

and they'll skin so here

1:27

is what her me immigraine looks like

1:30

Okay, so you can see that the left breast

1:33

is.

1:34

has diffuse trabecular and

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skin thickening and if you didn't appreciate

1:40

that just by, you know Imaging if

1:43

you looked at the if you

1:46

looked at the

1:48

Thickness of the breast the right breast

1:51

is 6.8 centimeters and the

1:54

left breast was 9.2 centimeters. So really the left

1:57

breast is very large very swollen and

2:00

indemnus so already you're starting to think

2:03

that this this is suspicious for inflammatory breast cancer.

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And and if you went in to go see the patient you would

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see the discrepancy of the size discrepancy and

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that's often how they present.

2:14

This is a beautiful case if anyone

2:17

knows what this is take them in and think of what what is

2:20

this study?

2:21

This is something we do here at Cooper. It's called

2:24

a contrast mammogram. If you've never seen it. It's

2:27

a really great study. Especially it's kind of like doing an

2:30

MRI in the same day as a mammogram. But basically you give

2:33

them contribute you do you give

2:36

them contrast and you do it's a dual energy mammogram, you

2:40

get low energy and subtraction images the

2:43

low energy. You look just like a regular mammogram.

2:47

And then the subtraction images will show you if there's

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any a normal enhancement and in her case, you could see that

2:53

you've got, you know, many enhancing masses throughout

2:56

the left breast.

2:58

And skin thickening and then she's also got this

3:01

little right breast mass that ends up being a fiberadenoma, but

3:04

it was certainly addressed. But now we know that she's

3:07

got multiple lesions. So now you could appreciate the skin thickening, you

3:10

know, she had that one lesion at six four, but

3:13

then she's got things at seven four. She's gonna have normal nose. She's

3:16

got things. She's got multi-centric cancer and

3:19

every quadrant. She's got the few

3:22

skin thickening abnormal axillary in

3:25

infocalicular atenopathy. This is

3:28

certainly a by Red five invasive thoughtful

3:32

with lobular features. This is what

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her PET CT look like so you could see like just

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to give you an idea and Cat Scan how asymmetric

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the breasts are but it's certainly enlarged you can

3:44

see that a few skin thickening and all the masses that

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are pet positive sdg positive in the left

3:50

breast.

3:53

And you can see all of her and that inopathy. So once it's

3:56

inflammatory by definition, you know, they're going

3:59

to have they might have that.

4:00

Swollen and put aurange appearance

4:03

of the breast.

4:05

You know, it can often mimic mastitis, but

4:08

in the clinical history has to be appropriate like it

4:11

has to be you know, you would

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if it was only going on for a short period of

4:18

time you would maybe try antibiotics, but at this point we were

4:21

suspicious and she went straight to you know, we kind of bypass the

4:24

whole mess by this argument.

4:26

All right any questions there please

4:29

chime in if you have anything?