IS Case 54: Ductal Carcinoma

Jerry Lee, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-19

History

A 42-year-old women had trauma to the left breast 4 weeks prior. Patient palpates a left breast lump near the site of trauma. The patient has not had a recent mammogram or clinical breast examination. She denies routine self-breast examinations.

Findings

Screening mammogram demonstrates a large, high-density, well-circumscribed mass which measures approximately 10 x 12 cm in the upper outer left breast. The right breast is normal. The breast tissue is composed of scattered fibroglandular elements. Targeted ultrasound of the abnormality demonstrates a heterogeneous mass with vascularity.

Diagnosis

Ductal Carcinoma

Discussion

Ductal carcinoma represents 65-80% of all breast cancers most common in patients over 40 years of age. Approximately 90% is sporadic and 10% is genetic. Clinically, there is a palpable thickening or firm lump on breast examination with abnormality on screening mammogram. The classic appearance is a dense mass with spiculated or microlobulated margins. Commonly there can be associated architectural distortion and calcifications, benign or malignant appearing. Ultrasound commonly demonstrates an irregular hypoechoic shadowing mass, taller-than-wide and can present with a dilated duct. Color doppler shows hypervascularity with penetrating vessels. Diagnosis is made with core biopsy. Extent of calcifications is important for surgical planning due to possibility of extensive intraductal component.

References

Kopans DB. Breast Imaging. 2nd Ed., Lippincott, Williams & Wilkins, 1998:107-34, 576-82.
Dogan BE, Ceyhan K, Tukel S, Saylisoy S, Whitman GJ. Ductal dilatation as the manifesting sign of invasive ductal carcinoma. J Ultrasound Med. 2005 Oct;24(10):1413-7. [PMID: 16179626]