0:01

Our next case is a 42 year old woman with

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a recent diagnosis of right breast

0:06

ductal carcinoma in situ for preoperative evaluation.

0:10

And I'm going to show you her MIP images.

0:14

And you can see that this woman has a lot of

0:16

background parenchymal enhancement.

0:18

She has segmental non mass enhancement with some

0:22

maybe some masses in the right medial breast,

0:26

and that's the location of her ductal carcinoma in situ.

0:30

We can also see that there's something

0:32

enhancing here in the left anterior lateral breast.

0:37

Focus or small mass.

0:40

So we're going to investigate further.

0:44

I'm going to pull in her T1

0:48

and her

0:50

first

0:52

post contrast subtracted image.

0:56

Just wanted to show you what she has here.

0:59

So this

1:02

this is her ductal carcinoma in situ, here in the medial

1:06

aspect of the right breast.

1:08

All of this segmental

1:10

non mass enhancement.

1:11

You can see that it just sort of continues along that medial side.

1:17

There had been a thought that this was actually a smaller size on

1:22

her pre MRI imaging and possibly because of dense tissue,

1:29

it wasn't possible to see all of this.

1:31

But MRI showed us the extent of disease on the right side and

1:37

it made it very likely that the patient was going to require

1:42

mastectomy to get clean margins,

1:48

and that was indeed what she had elected to do.

1:52

So, our focus then shifts to the other side because we want to be

1:57

sure there isn't anything else that we are...

2:00

should be concerned about, and this

2:03

little enhancing focus or small mass really stands out

2:07

with relation to the rest of the tissue.

2:10

Very bright.

2:12

We're going to look at our STIR sequence

2:17

to see if it's T2 bright.

2:20

And I think it's really hard to tell because her

2:23

breast tissue in that area is also so bright,

2:27

I don't think we can really tell about it.

2:30

And in this setting where the patient has breast cancer on the

2:34

right side, and we're probably going to need

2:38

a mastectomy on the right side,

2:39

it makes sense to do a biopsy of this area on the left.

2:45

And we can do, you know, some further investigation with other

2:49

sequences. This is the pre and post imaging.

2:53

We still see the same thing there and basically we decided to go

3:00

ahead and do a biopsy of this area, and we had

3:04

a result of atypical lobular hyperplasia.

3:07

So in the setting of her cancer on the right side,

3:11

the patient had an excisional biopsy of the left breast atypical

3:16

lobular hyperplasia, with no upgrade at surgery.