Invasive ductal carcinoma (NST)

Case contributed by Dr Bruno Di Muzio

Presentation

Routine screening. Previous history of right breast cancer.

Patient Data

Age: 65 years
Gender: Female

Standard mammographic 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 and magnification LEFT Breast)

mammography

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

Standard mammographic views (Round 4)

mammography

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

Targeted ultrasound - LEFT 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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