ICRI CASE OF THE WEEK
Contributed By : Dr Jwala Srikala DMRD, DNB
Senior Consultant Radiologist
Krishna institute of medical sciences, Hyderabad
Copyright of the Case belongs to : Dr Jwala Srikala
History
• 44 year old with complaints of lump in the left breast
since 6 months
CC & MLO Views of Left Breast
USG Left Breast
What is your Diagnosis
A) Fibroadenoma
B) Phylloides tumor
C) Papillary tumor
D) Invasive ductal carcinoma
Answer
• MUCINOUS SUBTYPE OF INVASIVE DUCTAL CARCINOMA
CC & MLO Views of Left
Breast show –
• A fairly well circumscribed
mass lesion in the
posterior depth of the
upper & outer quadrant of
left breast
• The anterior and lateral
margins of the lesion
shows microlobulations
(Thin arrows)
• There are no associated
microcalcifications or
distortion .
USG Left Breast shows-
• A fairly well-defined heterogeneously
hypoechoic mass with few cystic areas,
microlobulated margins & posterior
acoustic enhancement
Discussion
• Mucinous Carcinoma of the breast, also known as Colloid Breast Carcinoma,
is a subtype of invasive ductal carcinoma (IDC). They account for about ~ 2%
of breast cancers.
• Commonly seen in elderly women, about 7% in women over the age of 75
years, against 1% in younger women.
• Mammography –They commonly present as well circumscribed, lobulated,
low density masses because of the presence of mucin. Sometimes they may
have obscured or indistinct margins. About 20% can be occult on
mammogram. Calcification is rare in pure mucinous tumors.
• USG - On ultrasound they may present as mixed solid and cystic
masses with microlobulated margins, or as masses isoechoic to the
adjacent fat with posterior acoustic enhancement.
• MRI – Mucinous cancers are one of the few cancers which have a high
signal intensity on T2W sequences which is due to the water content
in the mucin. On post contrast scan, they may show benign kinetics
with gradual enhancement and may be mistaken for a benign tumor.
• Differential Diagnosis
• Medullary carcinoma
• Papillary tumors
• Metaplastic carcinoma
• Malignant phylloides
References
• Chopra S, Evans AJ, Pinder SE et-al. Pure mucinous breast cancer-
mammographic and ultrasound findings. Clin Radiol. 1996;51 (6): 421-4.
• Memis A, Ozdemir N, Parildar M et-al. Mucinous (colloid) breast cancer:
mammographic and US features with histologic correlation. Eur J Radiol.
2000;35 (1): 39-43.
• Bitencourt AG, Graziano L, Osório CA et-al. MRI Features of Mucinous
Cancer of the Breast: Correlation With Pathologic Findings and Other
Imaging Methods. AJR Am J Roentgenol. 2016;206
• Santamaría G, Velasco M, Bargalló X et-al. Radiologic and pathologic
findings in breast tumors with high signal intensity on T2-weighted MR
images. Radiographics. 2010;30 (2): 533-48