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:073
Age:47
Clinical presentation:Premenopausal woman with average risk of developing breast cancer presented with a lump in her right breast. On clinical examination, she had a hard lump in the upper outer quadrant of the right breast.


Mammography:


Breast composition:ACR category c (the breasts are heterogeneously dense, which may obscure small masses)
Mammography features:

 ‣ Location of the lesion:Right breast, upper outer quadrant at 10 o’clock, middle third
 ‣ Mass:
   • Number:1
   • Size:Not measurable in the dense breast parenchyma, approximately 2.0 cm
   • Shape:Irregular
   • Margins:Indistinct
   • Density:High
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:Coarse
   • Distribution:In mass
 ‣ Architectural distortion:Present
 ‣ Asymmetry:Focal
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Coarse calcifications in mass

Ultrasound:


Ultrasound features: Right breast, outer quadrants at 9–10 o’clock

 ‣ Mass
   • Location:Right breast, outer quadrants at 9–10 o’clock
   • Number:2
   • Size:
  • Lesion 1: 2.0 × 1.7 cm in upper outer quadrant at 10 o’clock position.
  • Lesion 2: 1.1 × 0.7 cm in outer quadrant at 9 o’clock position
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Spiculated
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Internal vascularity
 ‣ Special cases:None

BI-RADS:

BI-RADS Category: 5 (highly suggestive 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:Upper outer
   • Localization technique:Palpation
   • Nature of aspirate:Whitish
 ‣ Cytological description:Smears are very cellular and show loosely cohesive ductal epithelial cells. Many of these cells show nuclear pleomorphism, nuclear overlapping, and occasionally prominent nucleoli
 ‣ Reporting category:Malignant
 ‣ Diagnosis:Carcinoma – high grade
 ‣ Comments:None


Histopathology:

Breast-conserving surgery



Histopathology features:

 ‣ Specimen type:Breast-conserving surgery
 ‣ Laterality:Right
 ‣ Macroscopy:On cut surface of the specimen, a firm, poorly circumscribed area (2 × 1.2 × 0.8 cm) is seen, which is 0.3 cm from the base. Another whitish area of fibrosis (3.0 × 3.0 × 2.0 cm ) with a few cysts is 1.0 cm from the lateral margin
 ‣ Histological type:Invasive carcinoma of no special type
 ‣ Histological grade:Grade 3 (3 + 2 + 3 = 8)
 ‣ Mitosis:22
 ‣ Maximum invasive tumour size:Largest 3.0 cm in greatest dimension (another is 2.0 cm)
 ‣ Lymph node status:5/21
 ‣ Peritumoural lymphovascular invasion:Present
 ‣ DCIS/EIC:Solid and cribriform type – intermediate grade
 ‣ Margins:Free of tumour
 ‣ Pathological stage:pT2(2)N0
 ‣ Biomarkers:
 ‣ Comments:Benign proliferative breast disease such as UDH, cyst formation, and apocrine change

Case summary:

Premenopausal woman presented with lump in the right breast. Diagnosed as right breast carcinoma (multifocal), BI-RADS 5 on imaging, as carcinoma breast on cytology, and as invasive breast carcinoma of no special type, pT2(2)N0 on histopathology.

Learning points:


  • Heterogeneously dense breasts obscure optimal visualization of the breast mass lesions. Supplementary breast ultrasound in this case clearly shows the two foci of cancer, both in the same quadrant.

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.