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Atlas of breast cancer early detection

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Case number:012
Age:65
Clinical presentation:Postmenopausal woman with average risk of developing breast cancer presented with a left breast lump that she first noticed more than 4 months ago. Now presented with overlying skin changes and pain.



Mammography:


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

 ‣ Location of the lesion:Left breast, central portion of the breast, central zone, anterior and middle thirds
 ‣ Mass:
   • Number:Multiple
   • Size:Left retroareolar: Largest 5.5 × 3.0 cm, multiple satellite lesions (largest 2.5 × 1.0 cm) in outer quadrant at 4 o’clock
   • Shape:Irregular
   • Margins:Spiculated
   • 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:Skin thickening, nipple retraction

Ultrasound:


Ultrasound features: Left breast, lower quadrants at 6 o'clock

 ‣ Mass
   • Location:Left breast, lower quadrants at 6 o'clock
   • Number:Multiple
   • Size:Largest 3.8 × 1.8 cm
   • Shape:Irregular
   • Orientation:Not parallel
   • Margins:Spiculated
   • Echo pattern:Heteroechoic
   • Posterior features:No posterior features
 ‣ Calcifications:None
 ‣ Associated features:Skin thickening, vascularity in mass, axillary lymphadenopathy
 ‣ Special cases:None

BI-RADS:

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

Further assessment:

Further assessment advised: Referral for core biopsy

Histopathology:

Core needle biopsy



Histopathology features:

 ‣ Specimen type:Core needle biopsy
 ‣ Laterality:Left
 ‣ Macroscopy:Seven linear cores: longest is 20 mm in length and smallest is 7 mm in length
 ‣ Histological type:Invasive breast carcinoma of no special type
 ‣ Histological grade:Grade 2 (3 + 2 + 1 = 6)
 ‣ Mitosis:4
 ‣ Maximum invasive tumour size:
 ‣ Lymph node status:
 ‣ Peritumoural lymphovascular invasion:
 ‣ DCIS/EIC:
 ‣ Margins:
 ‣ Pathological stage:
 ‣ Biomarkers:
 ‣ Comments:

Case summary:

Postmenopausal woman presented with palpable left breast lump with skin changes. Diagnosed as large irregular high-density mass with spiculated margins in left breast with associated features of left breast areolar skin thickening, left nipple retraction, and left axillary lymphadenopathy, BI-RADS 5 on imaging and as invasive breast carcinoma of no special type on needle core biopsy histopathology.

Learning points:



  • Breast skin thickening on mammography and breast ultrasound is defined as skin > 2 mm thick. Focal breast skin thickening in the presence of an underlying breast mass indicates locally invasive breast cancer.


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