0:00

So in this case, we have a 65-year-old female

0:03

presenting for a routine screening, uh, mammogram.

0:08

We can see, uh, from these initial views

0:11

that the patient has had previous surgery

0:14

in the superior aspect of the right

0:15

breast and also within the right axilla.

0:19

Uh, from our clinical history, we know that she has

0:21

a history of cancer and she's been treated with

0:23

a lumpectomy and radiation.

0:25

We can see, uh, obviously the lumpectomy

0:27

changes here, um, but also, uh, the

0:29

skin thickening related to radiation.

0:33

We pull down just the right, uh, MLO view.

0:37

We can see that at a very

0:39

superior aspect of the image.

0:40

There is a, what looks like asymmetry up here,

0:43

and of course, any patient with a history of

0:45

cancer, uh, we need to, uh, be a little more

0:48

worried about any sort of finding that we see.

0:51

If we switch over to the, uh, DBT stack, we see,

0:55

um, uh, right away that it looks like this is

0:57

projecting more on the lateral side of the breast.

1:00

And we get to a point where we're, you

1:02

know, maybe seven or eight, uh, slices

1:05

in here and we can see our finding.

1:09

We see it as highest resolution.

1:10

Um, searching.

1:11

That's where its location is as we scroll

1:13

through, missing nothing else in that.

1:16

Her lumpectomy findings look stereotypical

1:20

with, uh, fat necrosis in the center.

1:23

So this imaging finding got called

1:24

back for some additional, uh, views.

1:28

We could suggest perhaps that this area might

1:32

be, uh, close to the skin or perhaps in the

1:35

skin, and suggest that to our, uh, colleagues

1:38

in our report in hopes that we might.

1:42

Do some more efficient imaging, uh, or at

1:44

least raise the possibility, uh, in our report.

1:47

So this patient, uh, ended up getting a

1:51

diagnostic exam, which I'll show here, and we can

1:56

see that our, uh, again, uh, we're a little more

1:58

focused on the superior part of the breast here.

2:02

And in this follow-up view, our technologist has

2:04

put a, a marker to note that there is a skin finding

2:07

that she can see, uh, while performing the exam.

2:10

This, uh, of course fits in well with what

2:12

we're potentially thinking as seeing

2:14

this might be related to the skin.

2:17

Um, and so, uh, of course we'd wanna

2:20

send this patient off to ultrasound to

2:21

verify where that finding is exactly.

2:24

The mammographic features are relatively benign.

2:27

It's an oval-shaped mass, circumscribed, um,

2:31

doesn't really have the appearance of a—

2:34

recurrence, which might be more irregular in shape or

2:37

maybe some spiculated margins or indistinct margins.

2:41

If we pull over the ultrasound, uh, on

2:42

this patient, we can see, uh, the, uh, the

2:45

sonographer has looked in the right breast.

2:47

Stereo concern, which is what we were

2:49

talking about, the axillary tail.

2:52

Um, and we can see that there's a, a very typical,

2:55

uh, skin-associated cyst, either epidermal

2:57

inclusion cyst or sebaceous cyst, um, projecting

3:00

right at that spot with imaging features that

3:02

match up with our mammogram ones, with being

3:04

oval in shape with circumscribed margins.

3:07

And we can see that we probably see potentially

3:10

a little tail here going up to the skin

3:11

surface with this classic skin-associated cyst.

3:14

Therefore benign, the patient can

3:16

just return to routine screening.