Infiltrating ductal carcinoma in a 17-year-old

Case contributed by Dr Garth Kruger

Presentation

Palpable lesion.

Patient Data

Age: 17
Gender: Female

Another case to illustrate both pathology but also management of a breast lesion. This case highlights the importance of diagnosis, but also the integral part appropriate management of a lesion plays in breast imaging. Look at each image in turn and answer the question before you move on or the case loses its value. These are all ultrasound images, not all from the same machine.

Ultrasound

Two years later

The same lesion two years later. The patient was lost to follow up and she is now 19 years old. 

The reader again makes reference to the atypical appearance and reiterates the previous recommendation for sampling. Birads IV.

Ultrasound

One year later (three years from initial imaging)

The reader this time phones the referring physician and speaks to the mother who came with the patient.  There is a significant language barrier.

There is some communication gap, but the referring MD promises to talk to the family concerning biopsy as the lesion has increased in size. 

Ultrasound

Six months later (3.5 years from initial imaging)

3.5 years after initial imaging the patient finally arrives for biopsy of the lesion which is now much bigger and has grown in height. The biopsy confirms an infiltrating ductal carcinoma in a 20 year old.

Case Discussion

This case is noteworthy for several reasons:

  1. Cancers in patients this young are very scarce. You are not going to see many. Most lesions like this will invariably turn out to be fibroadenomas on biopsy. This should not deter you from biopsy of lesions that do not meet criteria for benign. You are obliged to biopsy these lesions when you see them.
  2. There is an obligation to track Birads III and IV and see they are not lost to follow up.
  3. Lesions that are not clearly benign justify biopsy.
  4. It's unusual for a carcinoma in someone this young to grow so slowly over a period of almost 3 years. Generally cancers in patients this young tend to grow aggressively and metastasize early.
  5. Real time review is essential in breast ultrasound. Do not interpret these cases from static images. Either put your hand on it or put your foot in it.
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Case information

rID: 21554
Case created: 31st Jan 2013
Last edited: 10th Jul 2016
Systems: Breast, Oncology
Inclusion in quiz mode: Included

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