Imaging Report: July 5, 2017 - Right Breast Ultrasound

Procedure: US Breast RT Complete | Comparison: No priors
Reason for exam: Clinical finding — right retroareolar palpable lump.
Patient history (as recorded): "Right retro palp lump. PT felt it 5 years ago. It went away and came back 6 months ago. No MG ordered. No priors. Bilateral retro scanned."

Findings

Technique: A targeted sonographic evaluation was performed of the breast(s) in the area(s) of clinical interest. Breast composition: Fat lobules and uniformly echogenic bands of supporting structures (Cooper's ligaments) comprise the bulk of breast tissue. No discrete hypoechoic areas are present in the area scanned. Right breast: In the retroareolar region, corresponding to the palpable finding there is a immediately subdermal hypoechoic mass 2.3 x 1.6 x 0.6 cm size, heterogeneous without apparent vascularity. This appears be associated with the skin and/or nipple. No appreciable breast tissue. Assessment: CATEGORY 2 — BENIGN FINDING. Recommendations: Clinical evaluation. The masses subcutaneous tissue may be related to the nipple, but appears most likely related to the dermis rather than gynecomastia.

Quoted verbatim, including the report's original grammatical errors.

Mass Characteristics

Size

2.3 × 1.6 × 0.6 cm

Right retroareolar

Depth

Immediately subdermal

Associated with skin/nipple

Echotexture

Hypoechoic,
heterogeneous

Wider than tall

Vascularity

None apparent

No flow seen

Why this 2017 study is worth re-reading today:

The mass was called out as "most likely related to the dermis rather than gynecomastia" and as having "no appreciable breast tissue." This was a dermal/subdermal lesion, not glandular breast tissue — despite being worked up and later excised under a gynecomastia framing.
By patient report the lump was first noticed around 2012 ("felt it 5 years ago"), resolved, and recurred — i.e. a hard subcutaneous lesion at a fixed anatomic site that came and went, then persisted. That behavior matches the pattern described elsewhere in this record: lesions that begin as hard subcutaneous lumps and evolve at recurring sites.
This predates the 2021 onset of the current progressive skin disease by roughly nine years.
Limit: BI-RADS 2 means benign by imaging. The mass was excised in August 2017; the surgical pathology from that excision is not present in these records. Retrieving that pathology report — and, if blocks were retained, requesting mucin and amyloid stains on the archived tissue — would be a low-cost, potentially high-yield step.

Patient Details

Bishop, Tyler

DOB: 05/26/1987 | Age 30 | Sex: Male

Patient ID: 30000205475

Providers

Ordering: Danielle Weiss, MD

477 N. El Camino Real, Suite D200, Encinitas, CA 92024

Radiologist: Michael L. Tobin, MD

Authenticated 07/05/2017 13:56

Facility

Imaging Healthcare Specialists — Encinitas

477 N. El Camino Real, Suite A-102

Encinitas, CA 92024 | (858) 658-6500

Accession #: 01292851