Invasive lobular carcinoma

case3

Clinical History:

A 41 year old female patient presented with a new palpable mass in the left upper lateral quadrant. In regards to the patient’s family history, her mother developed breast cancer at 40 years of age, her sister at 38 years of age and her aunt at 30 years of age. On the mammogram, extensive dense breast parenchyma was noted on both sides, corresponding to an ACR4 classification, and thus a limited evaluation. On the basis of this exam alone, no tumor or architectural disorder could be detected. Due to the patient’s family history additional MR-Mammography was performed for further evaluation.

Diagnosis:

Lobular invasive carcinoma

MR Technique: 

1.5-T system (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany) using a standard bilateral breast coil. (A) T1-weighted 3D gradient-echo sequence (1.6 mm axial slice, field of view 320 mm, matrix 512×512, TR/TE 4/1.5 ms every 50 s) after bolus injection of 0.2 mmol of Gd-DOTA per kilogram of body weight, 4th of 6 series. (B) Corresponding subtracted T1-weighted 3D gradient-echo post contrast image. (C) Unenhanced T1-weighted 3D gradient-echo sequence (1.6 mm axial slice, field of view 320 mm, matrix 512×512, TR/TE 4/1.5 ms). (D) T2-weighted turbo spin-echo sequence (3 mm axial slices, field of view 320 mm, matrix 512×512, TR/TE 4400/104 ms).

Imaging Findings:

An extensive irregular tumor mass with prominent contrast enhancement in the left upper lateral quadrant is visualized. The tumor has a low signal on T2 weighted images. A type II signal-intensity curve (rapid signal increase followed by a plateau) was found on dynamic MRI measurements (not shown). The lesion measured 5 x 4.5 x 4 cm3. The diagnosis of a malignant breast tumor (invasive lobular) was confirmed by a core cut biopsy performed during a second-look ultrasound. The patient was scheduled for primary chemotherapy.