Kondo Senri, Oura Shoji, Honda Mariko
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada-city, Japan.
Department of Surgery, Izumiotsu Municipal Hospital, Izumiotsu-city, Japan.
Radiol Case Rep. 2025 Mar 15;20(6):2719-2722. doi: 10.1016/j.radcr.2025.02.099. eCollection 2025 Jun.
An 80-year-old woman with a left breast mass was referred to our department. Mammography showed an oval mass, 2.5cm in size, with circumscribed margins in her left breast. Ultrasound showed an oval tumor with circumscribed margins, heterogenous internal echoes including numerous punctate hyperechoic foci, and posterior echo enhancement. Magnetic resonance imaging (MRI) of the tumor showed low and high signal intensity on T1-weighted images and on fat-suppressed T2-weighted images, respectively. Kinetic curve assessment of the tumor showed a fast and plateau pattern. After the pathological confirmation of malignant cells, the patient underwent mastectomy and sentinel node biopsy. Postoperative pathological study showed that atypical cells formed irregularly arranged papillary nests and grew in a medullary fashion accompanied by massive lymphocyte infiltration, leading to the diagnosis of invasive ductal carcinoma with medullary features (IDCMF). Immunostaining showed that the tumor had a triple negative phenotype and a high Ki-67 labelling index of 52%. In conclusion, breast diagnostic physicians should note that IDCsMF show a fast and plateau enhancement pattern on MRI kinetic curve assessment. Furthermore, the presence of punctate hyperechoic foci in the tumor can be useful in distinguishing IDCsMF from medullary breast carcinomas.
一名80岁左乳肿物的女性被转诊至我科。乳腺钼靶显示左乳有一个大小为2.5cm的椭圆形肿物，边界清晰。超声显示一个边界清晰的椭圆形肿瘤，内部回声不均匀，包括许多点状高回声灶，后方回声增强。肿瘤的磁共振成像（MRI）在T1加权图像上呈低信号强度，在脂肪抑制T2加权图像上呈高信号强度。肿瘤的动态曲线评估显示为快速上升和平台期模式。在病理证实有恶性细胞后，患者接受了乳房切除术和前哨淋巴结活检。术后病理研究显示，非典型细胞形成不规则排列的乳头巢，呈髓样生长方式，伴有大量淋巴细胞浸润，诊断为具有髓样特征的浸润性导管癌（IDCMF）。免疫染色显示肿瘤具有三阴性表型，Ki-67标记指数高，为52%。总之，乳腺诊断医生应注意，IDCMF在MRI动态曲线评估中显示快速上升和平台期增强模式。此外，肿瘤中存在点状高回声灶有助于将IDCMF与乳腺髓样癌区分开来。
