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Thank you for joining me. I'm really excited

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to show hopefully up to eight cases

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today. Now. I will say

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that these are some very unusual and

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challenging cases, but I think they have widely applicable

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teaching points for

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everyday cases as well.

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So you should be able to see on your screen some

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routine mammogram

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views. I'll give you the history for this patient. This

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was the 31 year old woman. This was

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her Baseline mammogram. She has a two-week history

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of right breast pain a lump with mild

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transient erythema and briefly felt

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feverish and chilled and also experience

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some yellow sticky nipple discharge

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physical exam revealed about a 19.

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I'm sorry a nine by 13 centimeter firm

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right breast Mass from about

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eight to ten o'clock and partially in location

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was not fixed to the skin or chest wall.

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There was also a tender 1.5 centimeter, right?

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Axillary lymph node noted. The patient

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is not pregnant or breastfeeding and there's no family history of

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breast cancer other or other related malignancies.

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So I'm going to show you the images here again.

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this was a right breast symptom

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and here's the right breast images on

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the

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left side of the screen. I'm going to double click

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and enlarge this.

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So you can see there's some increased trabecular

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density and thickening.

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Especially when compared to the same area on the left side. We

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see the same thing on The mllo View.

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I'm going to enlarge that.

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And you can also see an enlarged lymph node here as

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well.

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So the next thing we did was go to ultrasound.

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Here are the ultrasound images of the area of

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concern you can see this was kind of the edge of that lump and

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then more getting into where the lump is. You can

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see this very large area of hypoechogenicity. The

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overlying fat is a demitus and

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the skin is thickened.

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And just going through that area here even more edematous

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change and skin thickening.

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more of the same

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and here's that right axillary lymph

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node.

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So at this point, I'd like to show the polling question

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for case one.

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And the question is which of the following of these diagnoses is

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most likely in this patient

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with these images.

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Okay, great. Looks like some of you got

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the right answer and some

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of you got what is a pretty much the primary differential

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so this

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Was granulomitous mastitis and the

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main differential is inflammatory breast cancer.

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So just briefly about granulomitous mastitis. This

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was she actually underwent two ultrasound

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guided biopsies, which showed

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chronic inflammation granulomas inflammation

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and even focal giant cell reaction several stains

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for various infectious organisms was performed

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and were all negative.

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This is an interesting and unusual.

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Scenario, although we seem to be seeing a lot more of it in our

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clinic for some reason the etiology of this is still

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unknown. It's unclear. There are some thoughts that

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it could be infectious that we just haven't located

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the organism and there's also really no

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consensus regarding treatment in our

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Clinic. We tend to use a combination of steroids and antibiotics there

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have been other reports of exciting these

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but as you can imagine in this patient this young

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patient, this is a very large area an excision would ideally be

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avoided.