Fig. 3

A 63-year-old female presented with a palpable mass in the left breast. a,b Mammography showed an irregular mass with partially obscured margins measuring 3.2 cm. (c) Directed ultrasound revealed a hypoechoic mass with irregular borders and posterior acoustic shadowing measuring 3.5 cm in the greatest dimension. d,e Core needle biopsy revealed invasive lobular carcinoma and a staging magnetic resonance image MRI was ordered (c and d). Note the irregular heterogeneously enhancing mass consistent with that seen on mammogram and ultrasound. MRI also revealed multiple smaller, enhancing masses suspicious for satellite lesions (arrows in (d,e)), as well as enlarged abnormal axillary lymphadenopathy (circle in (e)). Mastectomy revealed two adjacent tumors, the larger 5 cm and the smaller 3.5 cm, as well as 5 of 17 axillary nodes positive for metastatic disease