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Case number:065
Age:60
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with painless right breast lump. On examination, a hard non-tender lump was found in the right breast.


Mammography:


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

 ‣ Location of the lesion:Right breast, upper outer quadrant at 10 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:3.1 × 2.2 cm
   • Shape:Oval
   • Margins:Partly circumscribed and partly indistinct
   • Density:High
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:None

Ultrasound:


Ultrasound features: Right breast, upper outer quadrant at 10 ’o’clock

 ‣ Mass
   • Location:Right breast, upper outer quadrant at 10 ’o’clock
   • Number:1
   • Size:3.0 × 1.4 cm
   • Shape:Irregular
   • Orientation:Parallel
   • Margins:Partly circumscribed and partly indistinct margins
   • Echo pattern:Hypoechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:None
 ‣ Associated features:Internal vascularity
 ‣ Special cases:None

BI-RADS:

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

Further assessment:

Further assessment advised: Referral for cytology

Cytology:

Cytology features:

 ‣ Type of sample:FNAC (solid lesion)
 ‣ Site of biopsy:
   • Laterality:Right
   • Quadrant:
   • Localization technique:Palpation
   • Nature of aspirate:Mucoid
 ‣ Cytological description:Smears show malignant cells with a uniform regular nucleus; many cells are plasmacytoid with eccentric nuclei. Background shows mucinous material
 ‣ Reporting category:Malignant
 ‣ Diagnosis:Carcinoma
 ‣ Comments:None


Histopathology:

MRM



Histopathology features:

 ‣ Specimen type:MRM
 ‣ Laterality:Right
 ‣ Macroscopy:Cut section shows a well-circumscribed greyish white tumour (2.2 × 2.0 × 1.5 cm), with mucinous areas of soft consistency
 ‣ Histological type:Mucinous
 ‣ Histological grade:Grade 1 (3 + 1 + 1 = 5)
 ‣ Mitosis:Not identified
 ‣ Maximum invasive tumour size:2.2 cm in greatest dimension
 ‣ Lymph node status:0/22
 ‣ Peritumoural lymphovascular invasion:Not identified
 ‣ DCIS/EIC:Not identified
 ‣ Margins:Free of tumour
 ‣ Pathological stage:pT2N0
 ‣ Biomarkers:
 ‣ Comments:

Case summary:

Postmenopausal woman presented with lump in the right breast. Diagnosed as right breast mass of suspicious morphology, BI-RADS 4B on imaging, as mucinous carcinoma on cytology, and as mucinous carcinoma, pT2N0 on histopathology.

Learning points:


  • Mucinous carcinoma is a subtype of breast carcinoma most commonly seen in women older than 60 years. It is characterized by the presence of extracellular mucin. Mammography shows a mass with partly circumscribed and partly indistinct margins. Ultrasound shows posterior acoustic enhancement in more than 50% of cases.

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