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

Atlas of breast cancer early detection

                                                                                                                         Go back to the list of case studies
                                                                                                                         Click on the pictures to magnify and display the legends
Case number:102
Age:58
Clinical presentation:Postmenopausal woman with increased risk of developing breast cancer in view of family history of breast cancer in paternal aunt and maternal grandmother. She presented with a lump in the right breast. Examination revealed a 2.5 cm right breast lump at the 12 o’clock position.


Mammography:


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

 ‣ Location of the lesion:November 2010: No mass
 ‣ Mass:
   • Number:0
   • Size:None
   • Shape:None
   • Margins:None
   • Density:None
 ‣ 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


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

 ‣ Location of the lesion:October 2012: Right breast, central portion of the breast, upper inner quadrant at 12–1 o’clock, anterior third
 ‣ Mass:
   • Number:1 (this is the developing asymmetry)
   • Size:2.2 × 1.7 cm
   • Shape:Irregular
   • Margins:Spiculated
   • Density:High
 ‣ Calcifications:
   • Typically benign:None
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:Perilesional
 ‣ Asymmetry:Focal
 ‣ Intramammary node:None
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Architectural distortion

Ultrasound:


Ultrasound features: October 2012: Right breast, central portion of the breast at 12 o‘clock

 ‣ Mass
   • Location:October 2012: Right breast, central portion of the breast at 12 o‘clock
   • Number:1, developing asymmetry
   • Size:2.6 × 1.6 cm
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Indistinct
   • Echo pattern:Heteroechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:None
 ‣ Associated features:Internal vascularity
 ‣ Special cases:None

BI-RADS:

BI-RADS Category (2010): 1 (negative)
BI-RADS Category (2012): 5 (highly suggestive of malignancy)

Further assessment:

Further assessment advised: Referral for cytology

Cytology:

Cytology features:

 ‣ Type of sample:FNAC
 ‣ Site of biopsy:
   • Laterality:Right
   • Quadrant:12 o’clock, superior areolar margin
   • Localization technique:Palpation
   • Nature of aspirate:Whitish
 ‣ Cytological description:Cellular smears with pleomorphic malignant cells with prominent nucleoli within many stromal fibrous fragments
 ‣ Reporting category:Malignant
 ‣ Diagnosis:Carcinoma
 ‣ Comments:None


Histopathology:

Breast-conserving surgery



Histopathology features:

 ‣ Specimen type:Breast-conserving surgery
 ‣ Laterality:Right
 ‣ Macroscopy:Cut surface shows a fairly well-circumscribed tumour (2.5 × 1.5 × 2.5 cm)
 ‣ Histological type:Invasive carcinoma of no special type
 ‣ Histological grade:Grade 3 (3 + 3 + 2 = 8)
 ‣ Mitosis:15
 ‣ Maximum invasive tumour size:2.5 cm in greatest dimension
 ‣ Lymph node status:5/20
 ‣ Peritumoural lymphovascular invasion:Present
 ‣ DCIS/EIC:Solid and comedo DCIS – high grade
 ‣ Margins:Free of tumour
 ‣ Pathological stage:pT2N2
 ‣ Biomarkers:
 ‣ Comments:

Case summary:

Postmenopausal woman with increased risk of developing breast cancer presented with right breast lump. Mammography and breast ultrasound dated 2012 reveals a new irregular lesion in the right breast. Compared with an earlier mammogram dated 2010, follow-up reveals developing asymmetry in the right breast. Interval change is seen. Diagnosed as highly suggestive of malignancy, BI-RADS 5 on imaging, as carcinoma on cytology, and as invasive breast carcinoma of no special type, pT2N2 on histopathology.

Learning points:


  • Because of family history of breast cancer in two first-degree relatives (mother and sister), the woman requires regular surveillance with mammography. The developing asymmetry seen on comparison with a previous mammogram confirms the presence of a suspicious mass, probably a cancer. The presence of lymphatic tumour emboli on histology is considered an important prognostic factor and is associated with increased risk of distant recurrence.

IARC, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France - Tel: +33 (0)4 72 73 84 85 - Fax: +33 (0)4 72 73 85 75
© IARC 2024 - All Rights Reserved.