Case contributed by Dr S.Potsi

Diagnosis certain

Presentation

Hx:Known Ca colon. Palpable lump in left breast.

Previous mammograms(2016): ACR C,BIRADS 1

Patient Data

AGE: 53 years

GENDER: Female

Bilateral mammography:a new cluster of suspicious microcalcifications located in the left breast outer -superior quadrant.

Mammogram shows pleomorphic microcalcifications in a regional distribution compromising the outer -superior quadrant of the left breast.

There is also thickening of the skin and nipple retraction.

The imaging findings are highly suggestive of malignancy: BI-RADS 5.

Ultrasound: confirmed the mammographic lesion as a solid hypoechogenic nodule, as taller as wider, with irregular margins, and no clear internal vascularity.

Ultrasound guided core-biopsy: US-guided core biopsy using a 14G needle and 3 passes. No suspicious lymph nodes in the left axillary cavity.

Case Discussion

This case illustrates a highly suspicious lesion depicted on the routine mammogram which, regardless the result of the biopsy, should be excised. US-guided core biopsy confirmed a lobular carcinoma.

MICROSCOPIC DESCRIPTION:

Invasive carcinoma of the breast, composed of pleomorphic neoplastic cells, with grade 2 nuclei that contain small nucleoli.Few mitoses are observed.Some neoplastic cells contain intracytoplasmatic vacuoles.Neoplastic cells infiltrate the stroma singly or in small aggregates.

DIAGNOSIS:

Left breast biopsy, 2 o'clock: Lobular carcinoma.

Suggested articles

1. Mari Kikuchi, Hiroko Tsunoda, Tadashi Kaneshiro, Osamu Takahashi, Koyu Suzuki, Hideko Yamauchi, Taro Ichikawa, Shin-ichiro Kumita. A New Method for Differentiating Benign and Malignant Pleomorphic Clustered Calcifications in Mammography. J Nippon Med Sch. 2014;81(2):70-7. doi: 10.1272/jnms.81.70.

2. Kim SY, Kim HY, Kim EK, Kim MJ, Moon HJ, Yoon JH.Evaluation of malignancy risk stratification of microcalcifications detected on mammography: a study based on the 5th edition of BI-RADS.

Ann Surg Oncol. 2015 Sep;22(9):2895-901. doi: 10.1245/s10434-014-4362-6. Epub 2015 Jan 22.

3.Patricia Lorena Arancibia Hernández*, Teresa Taub Estrada, Alejandra López Pizarro, María Lorena Díaz Cisternasy Carla Sáez Tapia.Breast calcifications: description and classification

according to BI-RADS 5th Edition.Revista Chilena de Radiología, año 2016; 22(2): 80-91.