Fig. 2.1 a,b Digital mammography, MLO view.

Clinical Findings

Slightly increased parenchymal resistance in the upper quadrants of the right breast, compared to left. No palpable mass.

Fig. 2.2 Magnification view of the central region of the right breast.

Fig. 2.3a,b Sonography (comparison of upper outer quadrants bilaterally).

Fig. 2.4a–c Contrast-enhanced MRI of the breasts.

Fig. 2.5 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 2.6a,b Signal-to-time curves.

Ultrasound

There is a marked difference in the calibers of the milk ducts (right > left), a sign of possible duct ectasia in the right breast. No circumscribed lesion. US BI-RADS right 3/left 1.

Mammography

Asymmetric inhomogeneous dense parenchyma of ACR type 4. No opacities. Polymorphous (round, linear, v-shaped) microcalcifications within the dense parenchyma of the right breast visible in the enlarged view. BI-RADS right 5/left 1). PGMI: P.

MR Mammography

MRI shows no suspect findings on Tl -weighted images and on water-sensitive IR sequence. There is a suspicious segmental dendritic signal enhancement in the upper quadrants of the right breast after administration of contrast medium. Signal-time curve is unspecific. However, in cases with a dendritic enhancement pattern, the placement of an adequate region-of-interest (ROI) is difficult or impossible. MRI shows no circumscribed enhancing masses. MRI of the left breast is normal.

MRI Artifact Category: 2

MRI Density Type: 1

Preliminary Diagnosis

Extensive intraductal, possibly partially microinvasive tumor of the right breast.

Differential Diagnosis

Segmental adenosis, inflammation (both very unlikely).

Procedure

Stereotactic vacuum core biopsy of the right breast to obtain histological confirmation of preliminary diagnosis. Compression with the probe of one of the tissue samples retrieved in the area of a calcification, visible here, produced “blackhead”-like emissions from the core. This is evidence of the presence of intraductal tumor.

Fig. 2.7 Specimen radiography of some of the core biopsies with positive findings of microcalcifications (arrows).

Fig. 2.8a–c Specimen of a single core biopsy before and after compression of the tissue including the microcalcification. Photography of the necrotic comedo tissue (arrow) after compression.

Histology of the specimen

Comedo-type DCIS, Grade 2.