11/03/2026
🔁 Case Revisited | Case 9
Welcome to today’s case!
📍 Mammography
👉 Right breast: small focal asymmetry (MLO), middle breast
👉 Left breast: focal asymmetry + highly suspicious coarse heterogeneous calcifications (superior quadrants)
📍 Contrast-Enhanced Mammography (CEM)
👉 Left breast lesion: strong homogeneous enhancement (1)
👉 Right breast UOQ: additional lesion with moderate enhancement (2)
👉 Right breast focal asymmetry: no enhancement (3)
📍 Second-look Ultrasound
(prior US elsewhere: BI-RADS 2)
👉 Right 9 o’clock: oval lobulated hypoechoic mass (8×6×8 mm), avascular
👉 Right 10 o’clock: irregular hypoechoic mass, indistinct margins (7×8×6 mm)
👉 Left 12 o’clock: irregular hypoechoic mass, indistinct margins (8×8×7 mm)
Lymph nodes: normal.
🔴 Final diagnosis: synchronous bilateral breast cancer
1️⃣ Left 12: DCIS G1
2️⃣ Right 9: invasive cancer G1 (ER+, PR+, HER2−, Ki67 11%)
3️⃣ Right 10: fibroadenoma
⭐ Teaching points
Bilateral breast cancer accounts for ~3% of cases and may be synchronous or metachronous (usually defined within 3–6 months).
Risk factors:
🔺 Young age at first diagnosis
🔺 Lobular histology
🔺 Family history
🔺 BRCA1/2, CHEK2 mutations
Most SBBC in older patients are low-grade, ER+, HER2− tumors.
🏡 Take-home messages
✅ Always carefully evaluate both breasts in breast cancer patients
✅ MRI or CEM helps determine whether disease is unifocal, multifocal, multicentric, or bilateral
✨ Stay tuned for the next 👉
CEM
