Clinical Findings

Large, mobile lump in the upper c quadrant of the right breast. No axi lymph nodes palpable.

Fig. 74.1 Ultrasound.

Fig. 74.2 Color-coded Doppler sonography.

Fig. 74.3 Ultrasound. Panoramic view of the right breast.

Fig. 74.4a,b Digital mammography, CC view.

Fig. 74.5a,b Digital mammography, MLO view.

Fig. 74.6a–c Contrast-enhanced MRI of the breasts.

Fig. 74.7 Contrast-enhanced MR mammography. Maximum intensity projection.

Fig. 74.8a,b Signal-to-time curves.

Ultrasound

In the area of the palpable mass, ultrasound demonstrated an extensive tumor with multiple criteria of malignancy as well as increased peripheral vascularization in Doppler sonography. The best depiction of the lesion was in panoramic view because of its size. US BI-RADS right 5.

Mammography

The parenchyma was bilaterally predominantly lipomatous, ACR type 1. A massive, ill-defined, hyperdense mass was seen in the right breast. There were no accompanying microcalcifications and no other suspicious findings. BI-RADS right 5/left 1.

MR Mammography (in this case unnecessary)

MRI showed a lobulated, ill-defined tumor in the upper outer quadrant of the right breast, with marked central necrosis. Signal-time curves in the region of interest were typical for malignancy (N.B: The most significant curves in terms of malignancy are always used for the MRM score, even if some individual curves appear normal). Interestingly, in the region of the central necrosis, small hypervascularized nodules were depicted, their development evidently metachronous to the primary tumor growth.

MRI Artifact Category: 1

MRI Density Type: 1

Preliminary Diagnosis

Extensive carcinoma. No differential diagnosis.

Procedure

Histopathological analysis of the palpable lump by US-guided percutaneous core biopsy. In this case, even freehand technique would be feasible.

Histology

Carcinosarcoma cells, G4.

Fig. 74.9a,b The correlation between the MRI findings and the macroscopic sarcoma specimen with respect to the very active peripheral regions, nodular masses (arrows) and central necrosis.