Case 6 Clinical history Mastectomy for left-sided breast carcinoma 20 years previously. Presented with a one month history of a lump in the right breast. Imaging showed a well defined mass lesion, suspicious of malignancy; clinically the lump also appeared malignant. Needle core biopsy was performed. Histological appearances - A,B Sections show part of a papillary lesion in which there is a moderate degree of nuclear atypia and a focal cribriform architecture. The appearances are suspicious of a papillary carcinoma in situ. Triple approach summary Imaging (mammography and ultrasound) - Category A Clinical - Category A NCB - Suspicious, B4 Comment Had the NCB shown benign papillary features, the correct category would have been B3 - uncertain malignant potential. Management Wide local excision performed, without axillary dissection. Histological appearances - C-F The sections confirm a 30 mm circumscribed area of papillary carcinoma in situ , intermediate grade. Entrapped epithelial structures are seen within a pseudocapsule (E) but this is not interpreted as invasion. DCIS of intermediate grade is present in adjacent ducts (F). Local excision is complete. Further management Follow up only, in view of patient's age. Learning points · Most papillary lesions should be classified as benign of uncertain malignant potential - B3, because of sampling issues. · However, in the presence of nuclear atypia a suspicious diagnosis may be appropriate. · Care must be taken not to overdiagnose invasive carcinoma in the presence of entrapped epithelial structures in the 'capsule'. |
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| Organisation: FORPATH asbl  |
Coordination: Dr Bernard Van den Heule |
Host: Labo CMP |