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Invasive ductal carcinoma (NST)

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

Routine screening. Previous history of right breast cancer.

Patient Data

Age: 65 years
Gender: Female

Standard Mammo views Round 5

mammography

Standard mammographic views demonstrate scattered areas of fibroglandular density in keeping with BI-RADS level 2 or B of breast density. Within the left breast upper outer quadrant, there is a likely spiculated mass measuring approximately 1 cm in diameter, partially contemplated on the CC projection. Right breast scarring. 

Work-up views compression &...

mammography

Work-up views compression & magnification Lt Breast

Compression and magnification in CC and MLO, with extended view on the CC, confirms the spiculated margins of the lesion. 

Standard Mammo views Round 4

mammography

Moderate fibroglandular tissue. Right breast scarring. No suspicious lesion, calcification or stromal distortion.

Targeted US Lt Breast

ultrasound

At the region of interest, 2 o'clock 8 cm from the nipple in the left breast, there is a spiculated hypoechogenic mass which is taller than wider and has a thick echogenic rim. This measures approximately 10 x 9.3 x 8.4 mm. No suspicious left axilla lymph nodes. 

Case Discussion

This patient has a new highly suspicious lesion within the left breast upper outer quadrant in keeping with BI-RADS V / Nottingham A categories. US-guided core biopsy was offered, regardless the result of the biopsy, this lesion must come out surgically. 

Biopsy confirmed an invasive ductal carcinoma non-specific type. 

Histology

MACROSCOPIC DESCRIPTION: "Left breast 2 o'clock 8cm from nipple": Tan needle cores 17mm in aggregate.

MICROSCOPIC DESCRIPTION: Sections show predominantly fibrous stroma with small fatty areas. There are malignant cells both singly and a nested and linear architecture set within a desmoplastic stroma. The cells have pleomorphic hyperchromatic nuclei and mitoses are abundant. There is moderate background inflammation. 

DIAGNOSIS: Invasive carcinoma NST. 

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