【病例】浸润性导管癌1例X线钼靶影像表现

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.

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。

A diagnostic mammogram was ordered.

行钼靶扫描。(分别为LCC/LMO、RCC/RMO)

【病例】浸润性导管癌1例X线钼靶影像表现

【病例】浸润性导管癌1例X线钼靶影像表现

【病例】浸润性导管癌1例X线钼靶影像表现

【病例】浸润性导管癌1例X线钼靶影像表现

Ultrasound images

Ultrasound images of the left breast are shown below.

左乳超声图像如下所示。

【病例】浸润性导管癌1例X线钼靶影像表现

【病例】浸润性导管癌1例X线钼靶影像表现

【病例】浸润性导管癌1例X线钼靶影像表现

【病例】浸润性导管癌1例X线钼靶影像表现

Findings

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.

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。

Differential diagnosis

•Inflammatory breast cancer

•Mastitis

•Abscess

•Diabetic mastopathy

•Metastatic disease to the breast

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: Invasive mammary carcinoma

诊断:浸润性导管癌

Discussion

Advanced breast cancer

晚期乳腺癌

Clinical presentation

Patients with locally advanced breast cancer often present with a dominant and palpable mass, skin thickening/ulceration, nipple retraction, skin nodules, and/or adenopathy.

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。

Imaging features

•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.

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。

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