Ductal breast carcinoma

Case contributed by Dennis Odhiambo Agolah

Presentation

One and a half years left breast sub areola swelling -palpable fixed mass- post lactation with nipple retraction.

Patient Data

Age: 40 years
Gender: Female
ultrasound

A solidly fixed, relatively circumferential left breast subareolar solid tumor with distinctly spiculated outer borders with the spicules visibly non paralleling the breast tissue planes is noted. The lesion is heterohypoechoic in reflectivity and markedly shows multiple punctuate and scattered intra-tumoral microcalcification foci (hyper-reflective on B-mode grey mapping; hypo-reflective on inverted B-mode grey mapping).

Left nipple retraction appreciated during scanning however, no axillary lymphadenopathy bilaterally.

Histopathology notes:

Gross: Five stripes of whitish linear cores largest 1cm, all processed in the cassette

Histopathology:

  • Tumor type- Invasive ductal carcinoma
  • Tumor grade (Nottingham's criteria) - grade II
  • Surrounding breast tissues show- high grade DCIS
  • Lymphovascular invasion- present
  • Peripheral infiltration- absent

Diagnosis: Invasive grade II ductal carcinoma

Case Discussion

Besides the solidity, the spiculated outer borders and the visualized intra-tumoral innumerable micro-calcification foci of millimetric diameters seen, the lesion showed no overt posterior acoustic shadowing features. Of mention though, is of small sized vascular channels seen coursing within the lesion supero-medially with the ultrasound features (over all) being scored as BI-RADS 5 category (highly suspicious of malignancy).

Trucut ultrasound guided biopsy (images shown) was performed (under local anesthesia) and at least 5 samples retrieved for histopathological evaluation which yielded Grade II invasive left breast ductal carcinoma.

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