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Case number:072
Age:58
Clinical presentation:Postmenopausal 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 quadrant of the right breast.


Mammography:


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

 ‣ Location of the lesion:Right breast, upper inner quadrant at 12-1 o’clock, posterior third
 ‣ Mass:
   • Number:2
   • Size:2.0 × 1.4 cm and 0.8 × 0.5 cm
   • Shape:Irregular
   • Margins:Microlobulated
   • 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 quadrants at 12 o’clock

 ‣ Mass
   • Location:Right breast, upper quadrants at 12 o’clock
   • Number:1
   • Size:2.2 × 1.6 cm
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Angular
   • Echo pattern:Hypoechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Internal vascularity
 ‣ Special cases:None


Ultrasound features: Right breast, upper inner quadrant at 1 o’clock

 ‣ Mass
   • Location:Right breast, upper inner quadrant at 1 o’clock
   • Number:1
   • Size:1.0 × 0.6 cm
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Angular
   • 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 inner
   • Localization technique:Palpation
   • Nature of aspirate:Whitish
 ‣ Cytological description:Smears are very cellular and show loosely cohesive sheets of larger ductal epithelial cells with high N:C ratio, pleomorphism, and hyperchromatic nuclei
 ‣ Reporting category:Malignant
 ‣ Diagnosis:Carcinoma
 ‣ Comments:None


Histopathology:

MRM



Histopathology features:

 ‣ Specimen type:MRM
 ‣ Laterality:Right
 ‣ Macroscopy:On serial sectioning, two nodules 2.2 × 1.6 × 1.0 cm and 1.0 × 0.8 × 0.4 cm were seen 4.0 cm apart. Both were well circumscribed and firm in consistency
 ‣ Histological type:Invasive breast carcinoma of no special type
 ‣ Histological grade:Grade 3 (3 + 3 + 2 = 8)
 ‣ Mitosis:14
 ‣ Maximum invasive tumour size:Largest 2.2 cm (another smaller at 1.0 cm)
 ‣ Lymph node status:0/26
 ‣ Peritumoural lymphovascular invasion:Not identified
 ‣ DCIS/EIC:Solid and cribriform – intermediate grade
 ‣ Margins:Free of tumour
 ‣ Pathological stage:pT2(2)N0
 ‣ Biomarkers:
 ‣ Comments:

Case summary:

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

Learning points:



  • When there are two distinct breast tumours, the T category should be determined by the characteristics of the larger or higher T category cancer.

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