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The next case is a 76-year-old woman who

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came to us with a known left breast cancer.

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It was diagnosed at an outside facility,

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and they noticed an architectural

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distortion in the left breast.

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So they did a DBT-guided biopsy of the left

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breast, and we know that this is an invasive

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cancer, was mixed ductal and lobular features,

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low grade, ER/PR positive, uh, HER2-.

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So she comes to us, uh, for staging.

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This is her low energy images, uh, and we see a

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large circumscribed mass in the left upper breast.

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Otherwise, it's a heterogeneously dense breast tissue.

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A little less symmetric, more

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on the right than on the left.

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And we already have a clip there.

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So this is the prior biopsy site.

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This is the cancer site.

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And, uh, this is what we are

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seeing on the recombined images.

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So this is a contrary example to the cases of thin

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rim enhancement of, uh, so-called eclipse sign.

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This is not eclipse sign.

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So this is brightly enhancing,

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irregular enhancing rim.

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So this is something completely different

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and we have to take much more seriously.

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So first of all, uh, contrary to eclipse

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sign, uh, it's not a clean dark circle inside.

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There is some

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density in there.

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So there is some overlapping tissue, and

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plus the rim enhancement is a

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little too bright, and it's quite irregular.

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So this is the most irregular

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part, which is pointed out.

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So one important point, of course, is that

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we are comparing it to the prior images, uh,

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especially the images that were taken before the

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biopsy, and we see that that mass was not there.

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So this, uh, on the right is her full-field

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digital mammogram from the outside

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facility pre-biopsy, and only one month later.

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So we see that this is something new, and it's

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probably not a part of her original presentation.

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And, uh, these are examples of, uh,

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contrast-enhanced spot compression views.

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So you can do additional views, uh,

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with contrast— just not mag views,

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but spot compression views are possible.

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So, and again,

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we see that it's irregular.

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There's probably even a little enhancing

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mass if you manage to, you know, displace

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the hematoma, which, obviously, it is.

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So this is a hematoma with rim enhancement, which

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developed after the biopsy, but we are more interested

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in this little mass, which is right below it.

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So it's below it on the lateral

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spot compression recombined images,

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and it's, uh, medial on the craniocaudal spot

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compression recombined images.

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And I just noticed that there is

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still something within that.

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Uh, so it's not a clear-cut eclipse sign.

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And the inner part of that circle is

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not smooth, but is rather kind of irregular.

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So definitely not an eclipse sign,

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so you'll have to take it seriously.

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These are again, examples of ability

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to do a DBT under the same compression.

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And these are, uh, slice DBT slices, and you

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can see that there is some architectural

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distortion still to the side or like right below

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uh, that hematoma.

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Very subtle, but discernible,

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and that exactly corresponds to those areas

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of enhancement that we saw before.

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We did an ultrasound and mostly just saw

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the large hematoma, which, uh, there was a

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little bit of, uh, area of decreased echogenicity,

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which was difficult to say if it was

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sediment or it was really the original mass.

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And this is her clip, and she went for, uh,

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segmental mastectomy, and it confirmed invasive mammary

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carcinoma, low grade, 1.7 centimeters in diameter.

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Another point of this case is, uh,

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take a look at what we see on the skin.

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So you see these tiny little masses in this case.

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On the left, it's a recombined MLO

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image, and we just happened to be capturing

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that image right on the skin surface.

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So it's a little oval mass.

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This is her DBT slice, which shows

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that that mass is definitely on the skin.

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It is enhancing.

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And this is her, um, uh, her recombined image, and

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it shows actually several of these.

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So you see it's oval, circumscribed,

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enhancing, and it has a little dark rim around it.

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And that's the air trapped around it.

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That's a very nice sign that these are on the skin.

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And these are her DBT slices again, which show

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that these are little masses on the skin, and this

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is an example of how they look like on a patient.

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So, uh, cherry hemangiomas are

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very important to keep in mind.

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They are very common, and they can show on your

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recombined images as enhancing masses.

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So very good idea to start recognizing

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them and to get used to them so you don't

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confuse them with a malignant mass.