PreviousCase 1 Clinical history At the age of 57 years routine screening mammography showed an ill defined parenchymal deformity in the upper outer quadrant of the left breast. The lesion was shown to be a complex sclerosing lesion and no further action was taken. Subsequent mammography at the age of 62 years showed another ill defined parenchymal deformity, this time in the right upper outer quadrant. The lesion was impalpable. Ultrasound-guided needle core biopsy (NCB) was performed. Needle core histology - A,B Part of a lesion with desmoplastic and elastotic stroma containing entrapped epithelial elements; some of these appear normal and others show squamous features with atypia, possibly lacking a myoepithelial layer. The appearances are those of a sclerosing lesion with areas suspicious of invasive carcinoma (B4). Action In an attempt to clarify the picture staining with anti-smooth muscle actin was performed (C). This confirmed the suspicion of malignancy but was not conclusive. Conclusion Sclerosing lesion with foci suspicious of malignancy. Triple approach summary Imaging - Category A (probably malignant) Clinical - not relevant Histology - suspicious, B4 Management Repeat needle core biopsy - this revealed definite invasive carcinoma - B5. Accordingly wide local excision and axillary sampling were carried out. Final histology - D-G The section shows a low grade adenosquamous carcinoma arising in association with a complex sclerosing lesion (CSL), including papillomas. The tumour is shown best by immunostaining by Cam 5.2 (G). Learning points · Actin immunostaining can help in distinction between CSL and carcinoma but may not be conclusive. · Repeat needle core biopsy saved a two stage operation. |
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| Organisation: FORPATH asbl  |
Coordination: Dr Bernard Van den Heule |
Host: Labo CMP |