Case 41 Answer 3
The echogenic portion most likely represents tiny calcifications. There is no shadowing, but a confluent echogenic area may be seen with a high concentration of tiny calcs; in this case, so tiny that they are not seen mammographically. Fat within the breast has a hypoechoic appearance. Mixed echogenicity lesions are just as suspicious as hypoechoic lesions.
An ultrasound-guided core biopsy was performed. The pathologist reported papillary carcinoma with a hitch: it resembled ovarian cancer, so it was read out as either ovarian met or primary breast cancer. Check out the related case below.
A pelvic ultrasound was performed.
This cystic mass was removed, and found to be benign. SO, the breast mass was a primary papillary carcinoma. This is a rare subtype (about 1% of all breast cancers). It usually presents as a palpable cyst with a solid component in a slightly older patient. Prognosis is generally better than that of Infiltrating Ductal Carcinoma, NOS.