0:00

Okay, so we're going to move on to the second case.

0:05

So you can start by looking at the images here first. I'll

0:08

just

0:09

indicate that the image here on the far left

0:12

is the mlo.

0:14

from

0:17

about two years earlier

0:19

This was the next screening mammogram from about five

0:22

months to the symptomatic diagnostic mammogram and

0:25

I'll go over the symptoms in just a moment.

0:28

So again, this was in.

0:31

August

0:33

and this was back in May and this was I believe about a

0:36

year earlier. So take a look at the images.

0:39

The history here is this is a 75 year old woman

0:42

with new painless left breast

0:45

reddish purple discoloration and edema over

0:48

about a six-week period over the predominantly inferior

0:51

aspect of her left breast. And

0:54

again, this is if I didn't say so this is the left breast I'm showing

0:57

here.

0:58

As you can see there's some surgical Clips in a scar marker. She

1:01

does have a history of approximately eight years

1:04

earlier triple negative stage one a

1:07

breast cancer for which she underwent partial mastectomy

1:10

radiation and chemotherapy.

1:15

On physical exam and there was

1:18

the skin discoloration was noted and there was also a retro

1:21

area retro aerial or mass measuring 2.5 by

1:24

2.5 centimeters.

1:28

So hopefully what you can appreciate is just

1:31

in the short period of time between this image. It's

1:34

about five months and this image.

1:37

There's this development of this asymmetry here.

1:41

The other thing that I think you can notice in

1:44

retrospect or maybe more subtly is there's also

1:47

a lot of skin thickening around the nipple and

1:50

extending inferiorly.

1:52

In retrospect this may have actually started to develop

1:55

at this time if we compare back

1:58

to here.

2:00

I'm just going to move on to the ultrasound images.

2:04

So you can see this is the left breast subareolar region.

2:11

So you can see this is a very vascular area almost anechoic.

2:17

with lots of Edema and the surrounding

2:20

tissue I think in some ways this looks

2:23

similar to the last case that we just saw of granulomitous mastitis

2:26

and here again, is this area very echogenic

2:30

tissue surrounding this very hypoechoic material

2:36

right under the nipple and this is just the upper breath the

2:39

unaffected upper breasts showing what her

2:42

tissue looks like elsewhere.

2:44

again, lots of vascularity here

2:47

and here's a landscape View.

2:52

Her lymph nodes were normal.

2:54

Okay, and at this point, I'd like to ask the polling

2:57

question.

2:58

Okay, so you'll see this is actually the same question. That's

3:01

not a mistake.

3:04

Which of the following is most likely in this patient?

3:09

Okay, great. So.

3:12

It looks like most people thought this was

3:15

inflammatory breast cancer, which I think is a great thought in

3:18

this patient. I think the Clincher here

3:21

is actually I did her biopsy

3:24

myself and her skin discoloration

3:27

was actually quite remarkable. It

3:30

was very deep almost bluish

3:33

purple and I think that's actually a

3:36

very key history and someone with a history of Prior

3:39

breast radiation and this ended up being an angiosarcoma

3:42

secondary thought to be

3:45

secondary to her primary previously treated breast

3:48

cancer with radiation.

3:50

So just for interest I will show

3:53

you.

3:54

I will show you the MRI.

3:57

And this will just show.

3:59

extensive

4:01

enhancement interestingly that

4:04

much of involves the skin as well

4:07

as the underlying breast tissue along with a lot

4:10

of necrosis or not enhancement.

4:12

This is also.

4:14

Very nicely demonstrated on these MIP sequences

4:17

as well.