0:00

This is a, uh, 74-year-old female presenting

0:03

with a palpable abnormality in the left breast.

0:06

Image quality is good in this case and we can see

0:09

our palpable BB marker here in the lateral aspect

0:13

on the CC view.

0:14

In the superior aspect on the MLO view, I think

0:17

that her palpable finding is approximately, let's say

0:20

two o'clock position. The right breast is normal.

0:23

We see some very coarse, diffuse

0:25

calcifications, which are typically benign.

0:27

Nothing we need to...

0:31

On the left, we can see, um, some increased

0:35

parenchymal density here. Could be related

0:37

just to her heterogeneously dense tissue.

0:40

We see a variety of calcifications that are

0:42

typically benign, like these larger, round, and

0:44

coarse calcifications, which you see on both views.

0:48

In addition, however, we see some

0:49

very small, more faint calcifications, which

0:52

may, uh, even have, uh, at least fine,

0:55

amorphic morphology. Potentially

0:57

fine linear, fine linear branching.

1:00

We want to work that up with some additional

1:02

mammographic views to include magnification.

1:05

Finally, we also see, um, skin thickening

1:07

around the peri-areolar region, also the medial

1:10

and inferior aspect of the left breast.

1:14

We scroll through the DBT images starting

1:18

inferiorly, and again, see that skin thickening

1:21

present throughout which portion of the breast.

1:25

As we get into the region of these calcifications,

1:27

we can start to see some areas of architectural

1:29

distortion and probably masses in here.

1:32

Um, kind of a very bizarre appearance to the

1:35

breast parenchyma, um, which doesn't have a sort

1:38

of typical breast parenchymal appearance, right?

1:41

We see these calcifications to better effect,

1:44

right, by looking through the tomosynthesis, and we

1:46

can see they do match up with some branching,

1:49

um, forms, like for example, here or here.

1:53

These are all suspicious findings, which are

1:54

leading us to think this doesn't look good.

1:57

This looks like, uh, either an advanced

1:59

cancer or potentially inflammatory

2:00

cancer with that skin thickening.

2:03

On the MLO view, we see similar

2:04

findings of, uh, calcifications.

2:07

We see some distortion, a little bit of motion

2:09

here, which makes this a little more difficult too.

2:11

Um, certainly some distortion there, probably large.

2:17

Just getting,

2:19

uh, magnification views just to look at

2:21

those calcifications a little better.

2:23

And of course, we can see, uh, the calcifications to

2:26

much better effect here with the magnification views.

2:28

Um, with, uh, fine linear branching forms throughout.

2:32

Same thing is true on the ML view.

2:34

Um, we see those associated calcifications.

2:37

Uh, this patient was subsequently biopsied,

2:39

uh, in this region here by ultrasound,

2:41

which demonstrated invasive ductal carcinoma.

2:44

Skin thickening, which was later confirmed

2:47

by her referring provider with a skin

2:48

punch biopsy, and findings were all

2:50

consistent with inflammatory breast cancer.