0:00

Okay, so

0:03

64 year old female presents with a palpable mass

0:06

in the left breast

0:08

This is what her mammogram looks like. You can

0:11

see she's got some masses in the left breast.

0:14

a little bit of skin thickening here

0:19

So this is what her mammogram looks like. What is

0:22

your next step?

0:29

Okay, go to biopsy ultrasound MRI or

0:32

no further workup needed.

0:38

Good. So everyone did got that right? So

0:41

you're gonna want to go to Ultrasound, you know,

0:44

if this was a screener, then you would call her back you give

0:47

her a zero, but she's a diagnostic because of palpable or she

0:50

should be a diagnostic. So you're just gonna go into ultrasound. I'm just

0:54

gonna describe this but this is a complex cystic

0:57

mass. It's mixed sistic and solid it

1:00

certainly large this obviously needs to buy at sea,

1:03

but I just want to take a minute to I

1:06

talked my residence about this a lot, but the difference between a

1:09

complex versus a complicated cyst. So complicated

1:12

sis can or you know, probably benign you

1:15

can even call it a two or three depending on how you're feeling or

1:18

how many the appearance of what how many others she has in

1:21

the breath if it's palpable stuff like that. You know,

1:24

they have low level internal Echoes maybe something internal Temptations,

1:27

but nothing that looks suspicious. It's reasonable to get

1:30

a tour of three but a complex this has a

1:33

really high percentage of malignancy complexes have

1:36

solid components. They've got nodularity.

1:38

They've got thick internal Temptations those

1:41

definitely need to provide seed. So you cannot

1:44

use a word complicated and complex interchangeably.

1:47

That's what certainly be a complex mass. And you would want

1:50

to buy it see it so it'd be a birads four or five.

1:54

so all of the following are well circumscribed

1:57

cancers, except

2:00

In the panel here.

2:06

useless medullary tubular papillary or

2:09

invasive

2:15

Good. So yeah. Okay good. I said accept.

2:18

Yes. So tubular is typically a slow growing

2:21

spiculated math. All the

2:24

others medullary mucinous papillary are

2:27

all subtypes of invasive ductal that

2:30

are well circumscribed. So the reason in dates of

2:33

ductal fits on here is because there are you know,

2:36

these are all types of invasive ductile. So they're subtype and

2:39

because invasive ductal. Well, I'm Gonna

2:42

Leave This question here the most common type of well circumscribe cancer

2:45

is which

2:49

Good. Yeah, so invasive ductal is the most common because it's

2:52

just the most common overall, you know, triple negative

2:55

tend to be the most common invasive ductiles that

2:58

are round balls. They grow so fast, they don't even have

3:01

time to become a regular and speculated. So yeah,

3:04

and basic ductile is going to be the most common and like I said all these

3:07

are subtites of invasive ductal. So yeah, so going

3:10

back to this case you 64. It's a palpable math and

3:13

her left breast. That means she's a diagnostic mammogram. So

3:16

you're gonna want to go to ultrasound next certainly. It's

3:20

gonna need to biopsy. This is a buyer four or

3:23

five. This is a complex cystic mass.

3:25

Tubular is not well circumscribed.

3:28

It's a slow growing irregular speculative mass in

3:31

these abductal's most common. This is

3:34

what her T1 pre-contrast looked like.

3:37

So, you know, this is with fats attraction. So what's great

3:40

on T1, pre-- You've got

3:43

blood blood or protein so

3:46

mucine mucin is T1 bright. So this is a mucinous Cancer

3:49

and just to show you this is

3:52

what our path look like. So it says invasive to invasive ductal

3:55

cancer mucinous type. So that's why

3:58

it's a subtype of invasive ductal.

4:02

Okay.

4:03

So, um, I'm gonna stop

4:06

here to open it up for any questions. If you have any please

4:09

feel free to unmute yourself and ask a question.

4:12

If you have any questions that you

4:15

want to ask out loud, you could email me always follow

4:18

us on Instagram at the booby Docs.

4:20

And and I hope you found

4:23

this helpful. Thank you so much you guys, too.