An occult breast mass

A 69 year old woman was referred by her general practitioner to the rapid access breast clinic because of a two week history of painless swelling in the upper left breast. She had no history of nipple change or discharge, and she was otherwise well with no medical history of note. On clinical examination she had a firm, ill defined, and non-tender swelling above the left nipple, with no palpable axillary nodes. Free hand, fine needle aspiration was undertaken and she was referred for imaging. Bilateral mammography showed moderately dense breast tissue only, and no focal lesion was seen on ultrasound of the left breast.

Results of needle cytology showed benign cells only. Because of persisting clinical concern and the dense breast tissue seen on mammography, breast magnetic resonance imaging was performed. Figure 1⇓ is an axial post-contrast, fat saturated magnetic resonance image through the superior portion of the breasts. This is a sequence that removes the signal from normal breast tissue, thereby highlighting areas of enhancement only.