Uncommon Breast Mass

Abstract

A 40-year old female presented to the Breast Clinic with a painless lump in the right breast for one month with no associated fever, nipple discharge or skin redness. The patient gave a history of a hard, slightly painful lump in the left breast for which she had undergone breast conservation surgery. Review of the records revealed that the patient had an early stage invasive ductal carcinoma. On local inspection, the right breast was normal in size with no nipple retraction and obvious swelling. On palpation; a 5×4 cm soft mobile lump was felt in the upper outer quadrant. It was non-tender and the skin was freely mobile over it. A separate 2×2 cm firm, non-tender, mobile lump was palpated in the upper outer quadrant, below the larger lump. There were no palpable lymph nodes in the axilla. The left breast was asymmetrically small with a large scar as a result of the previous operation. On palpation, no lump could be palpated and there was no axillary lymphadenopathy. The patient was referred to the mammography unit for bilateral mammograms. Selected mammogram (Figs. 1, ​,2]2] and ultrasound images (Fig. 3) are given as below. Figure 1 Right mammogram with craniocaudal and mediolateral oblique views show a large mass in the upper outer quadrant with heterogeneous density containing both lucent and dense areas and showing a well-defined margin in part of its circumference. A smaller, ... Figure 2 A repeat previous mammogram of the same patient at six months (craniocaudal and mediolateral oblique views). Based on this comparison of the two mammograms more than 6 months apart with no change in the size or density of the lesions, a diagnosis of definite ... Figure 3 Sagittal and transverse images of the mammographic lesions showing larger lesion (5 × 3.5 cm) to be well defined, transversely oval, heteroechoic with no posterior acoustic shadowing or enhancement, with a well defined capsule around the entire ... Question What would be your diagnosis?