Case # 4
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68 year old female with biopsy-proven invasive lobular carcinoma
| Sagittal T2W FS |
Axial
T1W FS post gad |
 |
 |
MRI: Irregular, fluid-containing biopsy cavity; imaging performed 18 days after surgery
| Subtraction |
|
First post-enhancement phase
|
Third post-enhancement phase
|
Enhancement: Progressive, focally nodular enhancement of the cavity wall
Mammogram: recent postoperative changes without comparison
| Ultrasound |
 |
Irregular,
fluid-containing biopsy cavity. Hypoechoic nodularity along superior
border. |
|
| Diagnosis:
Invasive lobular carcinoma. Extensive tumor surrounding the site of
previous excisional biopsy |
|
| The
extent of residual tumor was prospectively underestimated. Only areas of
gross nodularity were identified as suspicious. Pathologically, even the
thin, smooth enhancing borders were extensively involved with tumor.
The literature
reports that sensitivity of MRI in detecting residual disease varies with the time the imaging is performed. Imaging is more specific the
further post surgery the patient is. Evaluation for residual tumor has
been recommended to be no earlier than 28 days post surgery.
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