Metastasizing infiltrating ductal carcinoma of the breast

Case contributed by Dr Mohammad A. ElBeialy


Left breast lump and pain since one year.

Patient Data

Age: 50 years
Gender: Female

Extremely dense fibro-glandular texture of both breasts with increased glandular elements. 

The left breast shows a relatively large, globular, ill-defined spiculated soft tissue mass in its upper inner quadrant (11- 12 o'clock position), measuring about 5.0 X 4.5 cm in diameter. The mass shows few clusters of suspicious micro-calcifications, surrounded by area of architectural distortion and causes mild nipple retraction.

Multiple bilateral round and ovoid mass lesions are seen scattered in both breasts with the largest right retro-areolar mass is about 3 X 2 cm. 

Normal contour and skin thickness of the right breast as well as nipple-areola complex with no suspicious clusters of micro-calcifications architectural distortion. 

Few small enlarged axillary lymph nodes are seen. 

Left breast


Ultrasound examination showed an ill-defined, deeply hypoechoic mass lesion, deeper than wide, with angular margins and infiltration of the breast parenchyma. The mass shows few echogenic foci of calcifications with increased vascularity on Doppler interrogation. 

Multiple cysts of variable size.

Chest X-ray shows erosion of the left 8th rib posterior aspect.

Case Discussion

This case shows fibrocystic disease of the breasts (mammary dysplasia)  with left breast upper inner quadrant infiltrating ductal carcinoma (BIRADS-V) as well as enlarged bilateral axillary lymph nodes. Left posterior 8th rib erosion (metastatic deposit). 

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