History:An81-year-oldwomanpresentstoherprimarycarephysician,reportingsixmonthsofleft-sidedskinrednessandnippleinversion.Shealsohasapalpablelumpintheleftbreast.
病史:81岁女性,向她的私人医生就诊时描述:左乳皮肤发红、乳头内陷6个月,左乳可触及肿物。
Adiagnosticmammogramwasordered.
行钼靶扫描。(分别为LCC/LMO、RCC/RMO)
UltrasoundimagesUltrasoundimagesoftheleftbreastareshownbelow.
左乳超声图像如下所示。
Findings
Bothbreastshavescatteredareasoffibroglandulardensity.Intheleftbreast,thereisaspiculatedmasscorrespondingsonographicallytoahypoechoicmasswithangularmarginsintheleftbreastat4oclock,cmfromthealveolarmargin.Thereisassociatednippleinversionandskinthickening.Thiscorrespondstothepalpableabnormalityandmeasuresapproximately35x0x36mm.Intheleftbreastatoclock,8cmfromthealveolarmargin,thereisanirregularhypoechoicovalmassmeasuringx10x3mmandcontaininganinternalcalcification,whichissuspiciousandmayrepresentaninvolvedintramammarylymphnode.Intheleftbreastat9oclock,6cmfromthealveolarmarginthereisa17xx18mmirregularhypoechoicmasswithposterioracousticshadowing,whichcorrespondstoarchitecturaldistortioninthemedialbreastonmammography,whichisalsosuspicious.Thereisanenlargedleftaxillarylymphnode,whichisvisiblebothmammographicallyandonultrasound.
影像表现
乳腺钼靶:双乳见散在纤维腺体样密度;左乳4点位见一分叶状肿物,大小约35x0x36mm,低回声,边缘成角。肿物可触及,并见乳头内陷及皮肤增厚。左乳点位见一不规则低回声卵圆形肿物,大小约x10x3mm,内见钙化,可能为乳腺内淋巴结。左乳9点位见一不规则低回声肿物,大小约17xx18mm,后方见声影,与乳腺钼靶上中部的结构扭曲相对应。钼靶及超声均可见左侧腋窝增大淋巴结。
Differentialdiagnosis
Inflammatorybreastcancer
Mastitis
Abscess
Diabeticmastopathy
Metastaticdiseasetothebreast
鉴别诊断
炎性乳腺癌
乳腺炎
脓肿
糖尿病性乳腺病
乳腺转移性疾病
Diagnosis:Invasivemammarycarcinoma
诊断:浸润性导管癌
DiscussionAdvancedbreastcancer
晚期乳腺癌
Clinicalpresentation
Patientswithlocallyadvancedbreastcanceroftenpresentwithadominantandpalpablemass,skinthickening/ulceration,nippleretraction,skinnodules,and/oradenopathy.
临床表现:局部晚期乳腺癌患者常表现为明显的可触及的肿物,皮肤增厚/溃疡,乳头内陷,皮肤结节,肿大淋巴结。
Imagingfeatures
Mammography:Mammographyoftendemonstratesalargemass,breastasymmetry,distortion,calcifications,skinthickening,skinulceration,nippleretraction,and/ordenseaxillarynodes.
Ultrasound:Onultrasound,thereisgenerallyalargemass,diffuseinfiltrativeechoes,diffuseshadowing,cutaneous/subcutaneousthickeningedema,and/oradenopathy.Involvednodesmaydemonstratealossofcentralhilarfat,centralnecrosis,andeccentriccorticalhypertrophy.OncolorDoppler,high-gradetumorscanappearhypervascular.
MRI:OnMRI,patientsmaypresentwithmultiplefociconsistentwithatumor.Theymayalsodemonstrateinvolvementofthepectoralis,intercostalmuscles,skin,ornipple.
影像表现
乳腺钼靶:常表现为较大肿物,乳腺不对称,结构扭曲,钙化,皮肤增厚,皮肤溃疡,乳头内陷,密实的腋窝淋巴结。
超声:常表现为较大肿物,弥漫浸润性回声,弥漫阴影,皮肤及皮下组织增厚、水肿,淋巴结肿大。受累的淋巴结表现为淋巴门脂肪消失,中心坏死,偏心性皮层萎缩。彩色多普勒超声示高级别肿瘤血供丰富。
MRI:肿瘤表现为多发病灶,可见胸大肌、肋间肌、皮肤及乳头受累。
往期相关内容:
乳腺浸润性导管癌(钼靶、超声、CT)
乳腺癌及多发性骨髓瘤肝转移之MRI表现
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