Presentation
One and a half years left breast sub areola swelling -palpable fixed mass- post lactation with nipple retraction.
Patient Data
A solidly fixed, relatively circumferential left breast subareolar solid tumour with distinctly spiculated outer borders with the spicules visibly non parallelling the breast tissue planes is noted. The lesion is heterohypoechoic in reflectivity and markedly shows multiple punctuate and scattered intra-tumoural 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:
- Tumour type- Invasive ductal carcinoma
- Tumour 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 visualised intra-tumoural 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 anaesthesia) and at least 5 samples retrieved for histopathological evaluation which yielded Grade II invasive left breast ductal carcinoma.
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