Presentation
Routine screening.
Patient Data
Right breast - cluster of pleomorphic calcifications in the right upper outer quadrant seen on the MLO view only.
Calcifications appear unchanged and do not layer.
This lesion was given a category A and a stereotactic biopsy was performed.
MACROSCOPIC DESCRIPTION: "Right breast calcs UOQ Cat A": Several cores of cream and yellow tissue 22x16x3mm in aggregate. A1.
MICROSCOPIC DESCRIPTION: The cores of breast parenchyma shows several dilated ducts with intermediate and high grade ductal carcinoma in situ of cribriform and micropapillary type with microcalcification. DCIS is not associated with necrosis. Infequent stromal microcalcifications are also present. In addition, there is a focus of infiltrating carcinoma NST 1.7mm in maximum dimension. No myoepithelial cells are demonstrated in immunostains. The cells are arranged in sheets and nests, with no tubule formation. Nuclei are moderately irregular and have small nucleoli. There are only rare mitoses. In immunostains, there is strong staining for estrogen receptors in >95% of the tumor cell nuclei, no staining for progestogen receptors and no complete membrane staining for HER-2 (score 0). About 30% of the cells are Ki67+.
DIAGNOSIS: Right breast calcifications UOQ: Infiltrating carcinoma NST, BRE grade 2, ER+, PR+, HER-2-, with high grade ductal carcinoma in situ.
Case Discussion
This case demonstrates invasive ductal carcinoma that presents as suspicious calcifications only without an associated mass.
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