Case number: | 054 |
Age: | 62 |
Clinical presentation: | Postmenopausal woman with average risk of developing breast cancer presented with right nipple retraction of duration 4 months. She had also noted a lump in the right breast a month before presentation. Examination revealed a hard lump, 6 cm in diameter, fixed to the rest of the breast tissue but not to the underlying muscles. Axilla was unremarkable. |
Breast composition: | ACR category a (the breasts are almost entirely fatty) | Mammography features: |
‣ Location of the lesion: | Right breast, upper outer quadrant at 10–11 o’clock, middle third |
‣ Mass: | |
• Number: | 1 |
• Size: | 4.6 × 4.1 cm |
• Shape: | Irregular |
• Margins: | Spiculated |
• Density: | High |
‣ Calcifications: | |
• Typically benign: | Vascular calcification |
• Suspicious: | None |
• Distribution: | None |
‣ Architectural distortion: | Present |
‣ Asymmetry: | None |
‣ Intramammary node: | None |
‣ Skin lesion: | None |
‣ Solitary dilated duct: | None |
‣ Associated features: | Skin retraction and nipple retraction |
Ultrasound features: Right breast, upper outer quadrant at 10 o’clock position | |
‣ Mass | |
• Location: | Right breast, upper outer quadrant at 10 o’clock position |
• Number: | 1 |
• Size: | > 3.0 cm in greatest dimension |
• Shape: | Irregular |
• Orientation: | Not parallel |
• Margins: | Spiculated |
• Echo pattern: | Hypoechoic |
• Posterior features: | Posterior shadowing |
‣ Calcifications: | None |
‣ Associated features: | Architectural distortion and skin retraction |
‣ Special cases: | None |
Cytology features: | |
‣ Type of sample: | FNAC |
‣ Site of biopsy: | |
• Laterality: | Right |
• Quadrant: | Upper outer |
• Localization technique: | Palpation |
• Nature of aspirate: | whitish |
‣ Cytological description: | Smears show mainly dispersed malignant cells. These cells have a high N:C ratio. Many cells show small cytoplasmic vacuoles in the cytoplasm |
‣ Reporting category: | Malignant |
‣ Diagnosis: | Carcinoma |
‣ Comments: | None |
Histopathology features: | |
‣ Specimen type: | MRM |
‣ Laterality: | Right |
‣ Macroscopy: | Cut surface shows a solid, whitish, firm to hard tumour (4.0 × 3.0 × 1.5 cm) with infiltrating margins. Tumour is situated at a depth of 2.0 cm below the skin. The base is 0.5 cm away from the tumour. A separate specimen labelled “muscle from base” was a single nodular brownish firm tissue bit (2.0 × 1.5 × 1.0 cm) |
‣ Histological type: | Infiltrating lobular carcinoma – right breast |
‣ Histological grade: | Grade 1 (3 + 1 + 1 = 5) |
‣ Mitosis: | 4 |
‣ Maximum invasive tumour size: | 4.0 cm in greatest dimension |
‣ Lymph node status: | 5/30 |
‣ Peritumoural lymphovascular invasion: | Present |
‣ DCIS/EIC: | Absent; lobular carcinoma in situ not seen |
‣ Margins: | Free of tumour. Sections from the “muscle from base” show only skeletal muscle fibres and are free of tumour invasion |
‣ Pathological stage: | pT2N2 |
‣ Biomarkers: | |
‣ Comments: |
Postmenopausal woman presented with right breast lump and right nipple retraction. Diagnosed as right breast carcinoma with skin and nipple retraction, BI-RADS 5 on imaging, as breast carcinoma on cytology, and as invasive lobular carcinoma, pT2N2 on histopathology. |
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