Home / Training / Manuals / Atlas of breast cancer early detection / Cases

Atlas of breast cancer early detection

Filter by language: English / Русский
                                                                                                                         Go back to the list of case studies
                                                                                                                         Click on the pictures to magnify and display the legends
Case number:056
Age:58
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with blood-stained nipple discharge from the left nipple. Examination did not reveal significant lumps in either breasts or axillae.



Mammography:


Breast composition:ACR category a (the breasts are almost entirely fatty)
Mammography features:

 ‣ Location of the lesion:Left breast, lower outer quadrant at 5–6 o’clock, middle third
 ‣ Mass:
   • Number:Multiple small intraductal
   • Size:Not measurable
   • Shape:Indistinct
   • Margins:Obscured
   • Density:Equal
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:Present
 ‣ Asymmetry:Focal
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:Multiple dilated ducts
 ‣ Associated features:Architectural distortion with linear opacities

Ultrasound:


Ultrasound features: Left breast, lower outer quadrant at 4 o’clock

 ‣ Mass
   • Location:Left breast, lower outer quadrant at 4 o’clock
   • Number:Ultrasound transverse scan left breast shows multiple dilated ducts with intraductal lesions along the walls of the ducts
   • Size:Largest 0.4 cm in greatest dimension
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Indistinct
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Duct changes: ectatic duct with intraductal lesion along the walls
 ‣ Special cases:None

BI-RADS:

BI-RADS Category: 4B (moderate suspicion of malignancy)

Further assessment:

Further assessment advised: Further imaging with breast MRI

MRI:


MRI features:
 ‣ MRI features:Amount of fibroglandular tissue: ACR category a (the breasts are almost entirely fatty). Background parenchymal enhancement: Minimal (< 25%), symmetrical

 ‣ Location:Left breast, lower quadrant
 ‣ Focus:No
 ‣ Mass:
   • Shape:No
   • Margin:No
   • Internal enhancement:No
   • Kinetic curve:No
 ‣ Non-mass enhancement:
   • Distribution:Intraductal and periductal non-mass-like enhancement in the inferior half at 5–8 o’clock
   • Internal enhancement:Heterogeneous
 ‣ Non-enhancing findings:No
 ‣ Associated features:Architectural distortion
 ‣ Axillary nodes:No


Cytology:

Cytology features:

 ‣ Type of sample:Nipple discharge
 ‣ Site of biopsy:
   • Laterality:Left
   • Quadrant:
   • Localization technique:
   • Nature of aspirate:Brownish yellow discharge
 ‣ Cytological description:Smear from nipple discharge shows predominantly foamy macrophages and a few haemosiderin-laden macrophages. Occasional clusters of ductal epithelial cells are seen showing nuclear atypia
 ‣ Reporting category:Atypical, probably benign
 ‣ Diagnosis:Atypical, probably benign. Category 3 of IAC Yokohama System is atypical, probably benign
 ‣ Comments:None


Cytology features:

 ‣ Type of sample:FNAC
 ‣ Site of biopsy:
   • Laterality:Left
   • Quadrant:Lower half
   • Localization technique:Palpation
   • Nature of aspirate:whitish
 ‣ Cytological description:Smear shows many dyscohesive clusters and scattered solitary plasmacytoid cells with large pleomorphic nuclei and moderate cytoplasm. Background shows presence of RBCs and many macrophages; a few are haemosiderin laden. Many fibroadipose tissue fragments are also seen
 ‣ Reporting category:Suspicious, probably in situ or invasive carcinoma
 ‣ Diagnosis:Suspicious, probably in situ or invasive carcinoma
 ‣ Comments:None


Histopathology:

MRM



Histopathology features:

 ‣ Specimen type:MRM
 ‣ Laterality:Left
 ‣ Macroscopy:On serial sectioning, a firm grey white area (7.8 × 3.0 × 2.5 cm) is seen in the central and lower quadrants. It is 3.0 cm from the skin and 1.5 cm from the base. The remaining breast tissue appears unremarkable
 ‣ Histological type:Intraductal papillary carcinoma with invasive carcinoma
 ‣ Histological grade:Grade 2 (3 + 2 + 1 = 6)
 ‣ Mitosis:3
 ‣ Maximum invasive tumour size:0.7 cm in greatest dimension
 ‣ Lymph node status:0/15
 ‣ Peritumoural lymphovascular invasion:Absent
 ‣ DCIS/EIC:DCIS of solid, micropapillary, papillary, and flat-type intermediate grade; EIC present with multiple foci of microinvasion
 ‣ Margins:Free of tumour, distance from nearest margin (i.e. base) 0.7 cm
 ‣ Pathological stage:pT1N0
 ‣ Biomarkers:
 ‣ Comments:The intraductal papillary carcinoma involves several large ducts, a few of which are cystically dilated with papillary carcinoma within the duct. Multiple foci of microinvasion are seen

Case summary:

Postmenopausal woman presented with left breast blood-stained nipple discharge, diagnosed as multiple dilated ducts with intraductal solid lesions in the left breast, BI-RADS category 4B on imaging, as suspicious, probably in situ or invasive carcinoma, left breast on cytology, and as intraductal papillary carcinoma with invasive carcinoma on histopathology.

Learning points:


  • Intraductal papillary carcinoma (papillary DCIS) is defined as a malignant non-invasive neoplastic proliferation with papillary architectural features occurring in the lumen of the ductal lobular system. The invasive component in this case was very small compared with the DCIS component.

25 avenue Tony Garnier CS 90627 69366, LYON CEDEX 07 France - Tel: +33 (0)4 72 73 84 85
© IARC 2024 - Terms of use  -  Privacy Policy.