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:111
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with a painful lump in her right breast. On clinical examination, she was found to have a large hard lump in the upper quadrant of her right breast with ulceration of the overlying skin.


Breast composition:ACR category b (there are scattered areas of fibroglandular density)
Mammography features:

 ‣ Location of the lesion:Right breast, upper outer quadrant at 11 o’clock, anterior, middle, and posterior thirds
 ‣ Mass:
   • Number:1
   • Size:7.2 × 4.7 × 5.3 cm
   • Shape:Irregular
   • Margins:Microlobulated
   • Density:High
 ‣ Calcifications:
   • Typically benign:Coarse heterogeneous
   • Suspicious:None
   • Distribution:None
 ‣ Architectural distortion:None
 ‣ Asymmetry:None
 ‣ Intramammary node:Reactive
 ‣ Skin lesion:None
 ‣ Solitary dilated duct:None
 ‣ Associated features:Skin retraction, coarse calcification, and axillary adenopathy


Ultrasound features: Right breast, upper outer quadrant at 11 o‘clock

 ‣ Mass
   • Location:Right breast, upper outer quadrant at 11 o‘clock
   • Number:1
   • Size:> 5.0 cm in greatest dimension
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Angular
   • Echo pattern:Hypoechoic
   • Posterior features:Posterior shadowing
 ‣ Calcifications:Coarse calcifications in mass
 ‣ Associated features:Skin retraction and thickening, and metastatic axillary lymphadenopathy
 ‣ Special cases:None


BI-RADS Category: 5 (highly suggestive of malignancy)

Further assessment:

Further assessment advised: Referral for core biopsy



Histopathology features:

 ‣ Specimen type:MRM
 ‣ Laterality:Right
 ‣ Macroscopy:On serial sectioning, a firm to hard, greyish white, well-circumscribed tumour is identified (4.5 × 4.0 × 3.5 cm) in the upper outer quadrant. Overlying skin shows an ulcerated indurated area (4.0 × 3.0 cm). The remaining breast tissue is unremarkable
 ‣ Histological type:Invasive carcinoma of no special type
 ‣ Histological grade:Grade 2 (2 + 2 + 1 = 5)
 ‣ Mitosis:8
 ‣ Maximum invasive tumour size:4.5 cm in greatest dimension
 ‣ Lymph node status:1/23
 ‣ Peritumoural lymphovascular invasion:Not identified
 ‣ DCIS/EIC:Not identified
 ‣ Margins:Skin ulceration and oedema
 ‣ Pathological stage:pT4bN1
 ‣ Biomarkers:
 ‣ Comments:Areas of calcification and ossification seen within the tumour

Case summary:

Postmenopausal woman presented with right breast lump with ulcerated skin. Diagnosed as right breast carcinoma with coarse calcifications within and overlying skin ulceration and thickening, BI-RADS 5 on imaging, as right breast carcinoma on cytology, and as invasive breast carcinoma of no special type, pT4bN1 on histopathology.

Learning points:

  • Tumour of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules) is pT4 and will be in stage group IIIB, irrespective of nodal metastases (i.e. whether N0, N1, or N2).

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.