Presentation
Left axillary mass for 1 month. No palpable breast lump, fever, or weight loss.
Patient Data
There is focal asymmetry with architectural distortion in the upper outer quadrant of the left breast.
Left-sided enlarged lymph nodes.
The left breast shows a spiculated hypoechoic lesion seen at 2:00 o'clock, measuring about 1.4 x 0.9 x 1.4 cm, as well as a few small areas of architectural distortion seen throughout the upper outer quadrant.
In this elastography, part of the lesion shows stiffness.
Few enlaregd pathological lymph nodes were seen in the left axilla, with decreased echogenicity, thickened cortex and increased peripheral vascularity, the largest measuring about 4.1 x 3 x 4.9 cm.
Pathology Report
Gross: specimen fixed labelled with patient's name, consists of multiple white to yellow fatty tissue needle core biopsies, the largest 1.4 x 0.2 cm. Submitted all in one cassette.
Microscopic: multiple breast core biopsies, two of which show infiltration by invasive ductal carcinoma, of intermediate nuclear grade, forming small nests and tubules, with foci showing single-file pattern, suggestive of lobular component "for confirmation by immunohistochemical stains for E-cadherin".
Diagnosis: left breast true cut biopsy; consistent with invasive ductal carcinoma.
Case Discussion
An example of focal asymmetry on mammography proved to be invasive ductal carcinoma with left axillary pathological lymph nodes.
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