Non-enhancing Malignant Lesions of the Breast: A Case Report and Review of Literature

Due to the elusive nature of invasive lobular carcinoma, mammography, ultrasound, and magnetic resonance imaging have their limitations in early detection. A 67-year-old woman presented for mammography and found retraction of breast parenchyma of the right breast. Magnetic resonance imaging and contrast mammography showed no contrast uptake in the region in question. Magnetic resonance imaging and ultrasound were found to be superior for the detection of invasive lobular carcinoma, with a sensitivity of more than 90%. On ultrasound examination, invasive lobular carcinoma may occur only with posterior acoustic shadowing. On breast magnetic resonance imaging, it is commonly described as an irregular mass and less commonly as non-mass enhancement. An additional advantage of magnetic resonance imaging is the higher detection rate of multifocal, multicentric, and contralateral breast lesions. The reason for no contrast enhancement in this particular tumor before neoadjuvant chemotherapy followed by enhancement after neoadjuvant chemotherapy is most likely at the molecular and histologic level and requires further investigation in similar cases.