History:An81-year-oldwomanpresentstoherprimarycarephysician,reportingsixmonthsofleft-sidedskinrednessandnippleinversion.Shealsohasapalpablelumpintheleftbreast.

病史：81岁女性，向她的私人医生就诊时描述：左乳皮肤发红、乳头内陷6个月，左乳可触及肿物。

Adiagnosticmammogramwasordered.

行钼靶扫描。（分别为LCC/LMO、RCC/RMO）

Ultrasoundimagesoftheleftbreastareshownbelow.

左乳超声图像如下所示。

Findings

Bothbreastshavescatteredareasoffibroglandulardensity.Intheleftbreast,thereisaspiculatedmasscorrespondingsonographicallytoahypoechoicmasswithangularmarginsintheleftbreastat4oclock,cmfromthealveolarmargin.Thereisassociatednippleinversionandskinthickening.Thiscorrespondstothepalpableabnormalityandmeasuresapproximately35x0x36mm.Intheleftbreastatoclock,8cmfromthealveolarmargin,thereisanirregularhypoechoicovalmassmeasuringx10x3mmandcontaininganinternalcalcification,whichissuspiciousandmayrepresentaninvolvedintramammarylymphnode.Intheleftbreastat9oclock,6cmfromthealveolarmarginthereisa17xx18mmirregularhypoechoicmasswithposterioracousticshadowing,whichcorrespondstoarchitecturaldistortioninthemedialbreastonmammography,whichisalsosuspicious.Thereisanenlargedleftaxillarylymphnode,whichisvisiblebothmammographicallyandonultrasound.

影像表现

乳腺钼靶：双乳见散在纤维腺体样密度；左乳4点位见一分叶状肿物，大小约35x0x36mm，低回声，边缘成角。肿物可触及，并见乳头内陷及皮肤增厚。左乳点位见一不规则低回声卵圆形肿物，大小约x10x3mm，内见钙化，可能为乳腺内淋巴结。左乳9点位见一不规则低回声肿物，大小约17xx18mm，后方见声影，与乳腺钼靶上中部的结构扭曲相对应。钼靶及超声均可见左侧腋窝增大淋巴结。

Differentialdiagnosis

Inflammatorybreastcancer

Mastitis

Abscess

Diabeticmastopathy

Metastaticdiseasetothebreast

鉴别诊断

炎性乳腺癌

乳腺炎

脓肿

糖尿病性乳腺病

乳腺转移性疾病

Diagnosis:Invasivemammarycarcinoma

诊断：浸润性导管癌

Advancedbreastcancer

晚期乳腺癌

Clinicalpresentation

Patientswithlocallyadvancedbreastcanceroftenpresentwithadominantandpalpablemass,skinthickening/ulceration,nippleretraction,skinnodules,and/oradenopathy.

临床表现：局部晚期乳腺癌患者常表现为明显的可触及的肿物，皮肤增厚/溃疡，乳头内陷，皮肤结节，肿大淋巴结。

Imagingfeatures

Mammography:Mammographyoftendemonstratesalargemass,breastasymmetry,distortion,calcifications,skinthickening,skinulceration,nippleretraction,and/ordenseaxillarynodes.

Ultrasound:Onultrasound,thereisgenerallyalargemass,diffuseinfiltrativeechoes,diffuseshadowing,cutaneous/subcutaneousthickeningedema,and/oradenopathy.Involvednodesmaydemonstratealossofcentralhilarfat,centralnecrosis,andeccentriccorticalhypertrophy.OncolorDoppler,high-gradetumorscanappearhypervascular.

MRI:OnMRI,patientsmaypresentwithmultiplefociconsistentwithatumor.Theymayalsodemonstrateinvolvementofthepectoralis,intercostalmuscles,skin,ornipple.

影像表现

乳腺钼靶：常表现为较大肿物，乳腺不对称，结构扭曲，钙化，皮肤增厚，皮肤溃疡，乳头内陷，密实的腋窝淋巴结。

超声：常表现为较大肿物，弥漫浸润性回声，弥漫阴影，皮肤及皮下组织增厚、水肿，淋巴结肿大。受累的淋巴结表现为淋巴门脂肪消失，中心坏死，偏心性皮层萎缩。彩色多普勒超声示高级别肿瘤血供丰富。

MRI：肿瘤表现为多发病灶，可见胸大肌、肋间肌、皮肤及乳头受累。

往期相关内容：

乳腺浸润性导管癌（钼靶、超声、CT）

乳腺癌及多发性骨髓瘤肝转移之MRI表现

感谢大家对熊猫的