Presentation
An asymptomatic old lady went for an Ayurvedic massage when a mass was incidentally detected in her right breast. She had similar lumps in other parts of her body which subsided over a period of time whilst this persisted. She visited the OP to assess the lump. Clinical examination revealed a lump in the superolateral quadrant of right breast with overlying skin retraction. No palpable axillary lymph nodes. The surgeon asked for a sonomammogram for further evaluation.
Patient Data
A 2.7x2.5cm lobulated fairly homogeneous radiodense lesion with ill defined peripheral spiculation is seen in the superolateral quadrant of right breast. Overlying skin retraction is seen. No intralesional micro/macro calcification.
Ultrasound correlation revealed a spiculated poorly marginated fixed hypoechoic lesion measuring 2.3x1.7cm in the 10-11 clock position 4.8cm from nipple, 2mm skin deep. The lesion shows marked intra lesional vascularity.
Case Discussion
Based on the sonomammographic findings, features are in favor of a malignant etiology and the right breast was categorized as BI-RADS V suggesting biopsy/surgical removal.
Patient underwent mastectomy and histopathology revealed cells which are moderately pleomorphic plasmacytoid with coarse chromatin and inconspicuous nucelolus. Numerous cells reveal intracytoplasmic vacuoles. Features suggestive of pleomorphic lobular carcinoma.
Operation revealed only one sentinel node.
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