0:01

Alright, we're going to go to case 2 now.

0:03

So, this is our compare and contrast case.

0:05

And I'm going to start with this image here.

0:09

What we've got here on the left is a

0:14

the subtraction image and on the right, I've got the subtraction image.

0:19

And these really sort of have most

0:20

of the information, but I'm going to scroll up and down.

0:23

Let's see if we can get this to zoom up a bit,

0:33

I'm just going to go up and down a little bit through that one on the

0:37

left hand image on the subtraction image.

0:46

And you could put that poll up please, Ashley.

0:56

This is a 64-year-old lady.

0:58

I'm going to withhold the rest of her history.

1:01

All right, let's look at the result of that one.

1:04

All right, so we've got most people voting

1:05

here for Paget disease, which is correct.

1:08

This is Paget disease.

1:09

And you can see here, in this particular patient,

1:14

that we really have very...

1:17

Let me just go into this.

1:19

We have very asymmetric, and in this case, superficial nipple enhancement.

1:24

You see, it really is the skin of this right nipple that is enhancing.

1:28

But not only that, we've got,

1:30

and she did present with Paget disease of the nipple.

1:33

We have this clumped segmental enhancement extending posteriorly,

1:41

and it really extends pretty much all the way up to the nipple.

1:46

You can see it coming up here in this area here, all the way up to the nipple.

1:51

It's very much seems to be forming along the ducts.

1:54

A very typical for DCIS.

1:57

And this is what we call typical for a clumped enhancement pattern.

2:00

You can imagine it, just like little

2:02

separate little foci of DCIS within that duct, but overall forming a segmental

2:09

or triangular shape distribution with the tip pointed towards the nipple.

2:15

Now, the other things that we talked about,

2:17

we talked about inverted nipple, which we saw before.

2:20

This nipple clearly is not inverted.

2:23

Obviously the past case, what we thought it was going to end up

2:27

being was a papilloma before we realized it was an inverted nipple.

2:30

And if we're seeing little focal enhancing

2:32

areas behind the nipple, they certainly are most typically a papillomas.

2:36

But nipples do enhance normally, but they should enhance

2:40

relatively symmetrically, although it's going to be an asymmetric

2:44

distribution if one of those nipples is enhanced.