Presentation
Presented with painless right breast lump for one year, no nipple discharge
Patient Data
Breast composition C. The breasts are heterogeneously dense, which may obscure small masses.
Focal increased density in the upper outer quadrant of the right breast. Focus of calcification is seen within.
Another small well-circumscribed oval equal density lesion is seen at the left retromammary region, which may represent a lymph node.
Bilateral breast vascular calcifications. No suspicious calcification. No skin thickening. No nipple retraction.
Enlarged right axillary lymph node. Subcentimeter benign-looking left axillary lymph nodes.
Case Discussion
Ultrasound right breast of this patient showed irregular, spiculated hypoechoic lesion with enlarged suspicious right axillary lymph node (no ultrasound images available).
Right breast lesion is highly suggestive of malignancy. BIRADS 5.
Patient went for a trucut biopsy by primary team.
Histology:
Macroscopic: multiple fragmented strips of yellowish-grayish tissue, measuring 3 mm to 10 mm in length.
Microscopic: levels show fibroadipose and tumor tissue cores formed by malignant epithelial cells arranged in solid nests and irregular infiltrative clusters. Glandular or tubular differentiation is focally seen. The malignant cells exhibit hyperchromatic and moderately pleomorphic nuclei with mostly inconspicuous nucleoli. Mitoses are seen up to 16/10HPF. No tumor necrosis, in situ component, perineural or lymphovascular invasion is identified. The surrounding stroma is desmoplastic.
Immunohistochemistry:
- Estrogen receptor: negative
- Progesterone receptor: negative
- C-erb B2 oncoprotein: Equivocal (2+)
Interpretation: right breast invasive carcinoma, Modified Bloom and Richardson Grade 2.
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