History: An 81-year-old woman presents to her primary care physician, reporting six months of left-sided skin redness and nipple inversion. She also has a palpable lump in the left breast.
A diagnostic mammogram was ordered.
Ultrasound images of the left breast are shown below.
Both breasts have scattered areas of fibroglandular density. In the left breast, there is a spiculated mass corresponding sonographically to a hypoechoic mass with angular margins in the left breast at 4 o\’clock, 2 cm from the alveolar margin. There is associated nipple inversion and skin thickening. This corresponds to the palpable abnormality and measures approximately 35 x 20 x 36 mm. In the left breast at 2 o\’clock, 8 cm from the alveolar margin, there is an irregular hypoechoic oval mass measuring 22 x 10 x 23 mm and containing an internal calcification, which is suspicious and may represent an involved intramammary lymph node. In the left breast at 9 o\’clock, 6 cm from the alveolar margin there is a 17 x 22 x 18 mm irregular hypoechoic mass with posterior acoustic shadowing, which corresponds to architectural distortion in the medial breast on mammography, which is also suspicious. There is an enlarged left axillary lymph node, which is visible both mammographically and on ultrasound.
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35 x 20 x 36 mm，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2点位见一不规则低回声卵圆形肿物，大小约22 x 10 x 23 mm，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17 x 22 x 18mm，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。
•Inflammatory breast cancer
•Metastatic disease to the breast
Diagnosis: Invasive mammary carcinoma
Advanced breast cancer
Patients with locally advanced breast cancer often present with a dominant and palpable mass, skin thickening/ulceration, nipple retraction, skin nodules, and/or adenopathy.
•Mammography: Mammography often demonstrates a large mass, breast asymmetry, distortion, calcifications, skin thickening, skin ulceration, nipple retraction, and/or dense axillary nodes.
•Ultrasound: On ultrasound, there is generally a large mass, diffuse infiltrative echoes, diffuse shadowing, cutaneous/subcutaneous thickening edema, and/or adenopathy. Involved nodes may demonstrate a loss of central hilar fat, central necrosis, and eccentric cortical hypertrophy. On color Doppler, high-grade tumors can appear hypervascular.
•MRI: On MRI, patients may present with multiple foci consistent with a tumor. They may also demonstrate involvement of the pectoralis, intercostal muscles, skin, or nipple.