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Cases of the Day ¹

Breast Imaging Case of the Day

¹ From the Departments of Radiological Sciences (D.C.) and Pathology (P.M.C.), University of California, Irvine Medical Center, 101 The City Drive, Orange, CA 92868-3298. Received June 17, 1999; revision requested June 29 and received July 23; accepted July 23. Address reprint requests to D.C.

View larger version (95K): [in a new window]   Figure 1a.   (a, b) Craniocaudal (a) and mediolateral oblique (b) mammograms demonstrate an abnormally enlarged (1.7-cm) and dense node in the left axillary tail (arrow in b). An additional mediolateral oblique mammogram (not shown) was obtained to evaluate the region of the pectoral muscle. The node had more than doubled in size since a previous mammogram (not shown) obtained 1 year earlier. (c) Coned-down mediolateral oblique mammogram better depicts the abnormal density of the node without a clearly defined, radiolucent hilus. Subtle asymmetry and distortion of the left breast, apparent only on the craniocaudal view (cf a), was identified retrospectively.

View larger version (101K): [in a new window]   Figure 1b.   (a, b) Craniocaudal (a) and mediolateral oblique (b) mammograms demonstrate an abnormally enlarged (1.7-cm) and dense node in the left axillary tail (arrow in b). An additional mediolateral oblique mammogram (not shown) was obtained to evaluate the region of the pectoral muscle. The node had more than doubled in size since a previous mammogram (not shown) obtained 1 year earlier. (c) Coned-down mediolateral oblique mammogram better depicts the abnormal density of the node without a clearly defined, radiolucent hilus. Subtle asymmetry and distortion of the left breast, apparent only on the craniocaudal view (cf a), was identified retrospectively.

View larger version (80K): [in a new window]   Figure 1c.   (a, b) Craniocaudal (a) and mediolateral oblique (b) mammograms demonstrate an abnormally enlarged (1.7-cm) and dense node in the left axillary tail (arrow in b). An additional mediolateral oblique mammogram (not shown) was obtained to evaluate the region of the pectoral muscle. The node had more than doubled in size since a previous mammogram (not shown) obtained 1 year earlier. (c) Coned-down mediolateral oblique mammogram better depicts the abnormal density of the node without a clearly defined, radiolucent hilus. Subtle asymmetry and distortion of the left breast, apparent only on the craniocaudal view (cf a), was identified retrospectively.

View larger version (123K): [in a new window]   Figure 2.   Chest CT scan demonstrates enlarged intramammary and axillary nodes as well as asymmetric density in the left breast.

View larger version (79K): [in a new window]   Figure 3a.   Prone lateral (a) and supine anterior (b) scintimammograms demonstrate a large, multiloculated area of uptake in both the medial and lateral left upper breast. An additional focus of uptake is identified in the lower inner breast (arrow in b) as well as two foci of uptake in the left axilla (arrow in a).

View larger version (119K): [in a new window]   Figure 3b.   Prone lateral (a) and supine anterior (b) scintimammograms demonstrate a large, multiloculated area of uptake in both the medial and lateral left upper breast. An additional focus of uptake is identified in the lower inner breast (arrow in b) as well as two foci of uptake in the left axilla (arrow in a).

View larger version (182K): [in a new window]   Figure 4a.   (a) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows cancerous cells in the lymph node, occasionally in single file arrangements (arrows), including signet ring cells with numerous cytoplasmic vacuoles. (b) Photomicrograph (original magnification, x400; mucicarmine stain) demonstrates that the signet ring cells contain mucin, which is apparent from the pink color of the droplets. (c) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) of a left mastectomy specimen demonstrates infiltrating lobular carcinoma of the breast. The diagnostic characteristics of the tumor include relatively small, uniform tumor cells in single file or small nests or occasionally as single cells. Some of the tumor cells are vacuolated signet ring cells (arrows).

View larger version (178K): [in a new window]   Figure 4b.   (a) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows cancerous cells in the lymph node, occasionally in single file arrangements (arrows), including signet ring cells with numerous cytoplasmic vacuoles. (b) Photomicrograph (original magnification, x400; mucicarmine stain) demonstrates that the signet ring cells contain mucin, which is apparent from the pink color of the droplets. (c) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) of a left mastectomy specimen demonstrates infiltrating lobular carcinoma of the breast. The diagnostic characteristics of the tumor include relatively small, uniform tumor cells in single file or small nests or occasionally as single cells. Some of the tumor cells are vacuolated signet ring cells (arrows).

View larger version (176K): [in a new window]   Figure 4c.   (a) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows cancerous cells in the lymph node, occasionally in single file arrangements (arrows), including signet ring cells with numerous cytoplasmic vacuoles. (b) Photomicrograph (original magnification, x400; mucicarmine stain) demonstrates that the signet ring cells contain mucin, which is apparent from the pink color of the droplets. (c) Photomicrograph (original magnification, x400; hematoxylin-eosin stain) of a left mastectomy specimen demonstrates infiltrating lobular carcinoma of the breast. The diagnostic characteristics of the tumor include relatively small, uniform tumor cells in single file or small nests or occasionally as single cells. Some of the tumor cells are vacuolated signet ring cells (arrows).