31-year-old woman with palpable lump and skin redness in left breast
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Our next case is a 31-year-old woman.
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with a palpable lump in the left breast
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and redness of the left breast skin.
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So this patient was over 30 years old.
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She's 31.
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So we started with a bilateral mammogram.
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And we have our CC images on the top of the
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screen and MLO views on the bottom of the screen.
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And you can see right away,
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comparing the two sides,
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There is a lot of asymmetric density
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in the left breast, particularly in the
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upper part of the breast and lateral,
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but also extending across the midline.
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Her skin is thick.
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She's really not as well compressed
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on the left side as on the right side.
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And you know, part of that is due
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to the, you know, just the tissue
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asymmetry and discomfort in this breast.
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So we'll look at that left
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side a little bit more closely.
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Here's our CC view.
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You can see the skin is a little bit thick.
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There's a lot of asymmetry there.
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We'll go through our tomosynthesis images.
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We can see a lot of tissue density there.
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No obvious masses really, but,
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you know, definitely some tissue density.
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There's a suggestion of
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some masses here centrally.
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And then looking at the MLO view, again,
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lots of asymmetry in that upper, mostly in the
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upper breast and on our tomosynthesis images.
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We just have that sort of conglomerate tissue
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there in the central upper breast with maybe
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a suggestion of some more mass-like areas.
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And of course, this is our chance
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to look at the other breast as well.
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So we just want to make
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sure that that side is okay.
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And here's our CC view
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and our tomosynthesis views showing
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some heterogeneous normal breast tissue.
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And tomosynthesis images through the right MLO (mediolateral oblique) view,
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but really, the tissue looks okay on this
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side, much more abnormal-looking on the left.
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So we went ahead and did an ultrasound.
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That's the next step.
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And really wanted to focus on this left side here.
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So this is the left breast in
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those areas that are palpable.
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And you can see that there are
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multiple hypoechoic masses.
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Um, that are interconnected with
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these kind of tubular connections.
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And here's one of the palpable areas that
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was a little over two centimeters in size.
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Lots of blood flow to this whole area and a
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thick lymph node, lymph node with a thick cortex
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measuring up to seven millimeters in thickness.
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So this was really suspicious for breast cancer.
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The skin is thick, it was inflamed,
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there were multiple interconnected masses, and an
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abnormally thickened um, lymph node cortex.
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So biopsy was recommended for one of the masses
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and for the large left axillary lymph node.
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And the result was acute and chronic
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inflammation with non-necrotizing
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granulomas with surrounding cystic spaces
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and associated neutrophils suggesting
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cystic neutrophilic granulomatous mastitis.
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And that's the one that's sometimes
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related to the Corynebacterium infection.
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And the lymph node was found to
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be reactive, so no malignancy.
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This was all granulomatous mastitis.
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
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