Primary Intermammary Breast Carcinoma Presenting With Direct Sternal Invasion: A Diagnostic Pitfall of Standard Screening Mammography.
Rachel Deming, Michael Fei, Harsha Choudary Pudhota et al.
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Case in brief
An 85-year-old woman noticed a hard, non-tender sternal nodule despite an unremarkable screening mammogram 8 months earlier. Targeted ultrasound and PET-CT identified a hypermetabolic presternal mass; diagnostic mammography also failed to adequately show it. Biopsy demonstrated ER-positive, PR-positive, HER2-negative adenocarcinoma consistent with breast origin. Although initial staging showed no distant metastases, resection pathology revealed direct sternal invasion, and partial sternectomy was required.
What made this case unusual
The intermammary breast carcinoma presented with direct sternal invasion, while both routine screening and subsequent diagnostic mammography failed to adequately visualize the lesion.
Diagnostic / clinical pearl
A palpable parasternal mass warrants targeted imaging even after a recent negative screening mammogram, because standard mammographic views may not adequately show the intermammary area.