Tubular carcinoma

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Case No. 96/07
Patient Age: 50
Submitted by: Dr J Boyages
Institution: Westmead Hospital
Date: 21 OCT 1996 

HISTORY

May 1996:

Underwent a routine screening mammogram at a private centre

Not aware of any symptoms, two previous 'screening' mammograms were normal

Menarche - 12 years old

G3 P3

Aged 22 at first pregnancy

HRT since 1992

Family history:Maternal cousin developed breast cancer at age 48

Peri-menopausal

No significant past history

 

8/5/96: Private Diagnostic Breast Centre

Mammography:

1cm "non-specific increase in density" left breast12 o'clock position9cm from nipple

no microcalcification

 

Ultrasound:no lesion identified

Physical examination:Impalpable

Recommendation: Referral for diagnostic open biopsy

21/5/96: Needle localised excision biopsy at a local private hospital

HISTOPATHOLOGY

No frozen section.

Macroscopic:

Specimen A. Labelled "Wire localised right breast lump". Specimen consists of an ovoid portion of fatty breast tissue measuring 90x55x20mm with a localising wire projecting from one edge. No macroscopic lesion is seen.
Specimen B. Labelled "Extra breast tissue". Specimen consists of an ovoid portion of fatty breast tissue measuring 45 x 50mm x up to 12mm in thickness. No macroscopic lesion is seen.
Specimen C. Labelled "Excision lower breast cavity". Specimen consists of an irregular portion of fibrofatty breast tissue measuring 50x30x15mm. This portion of tissue is firm and nodular and the cut surface shows a firm white nodule which measures 10mm in diameter.

Microscopic:

Specimens A and B. Both specimens show predominantly fatty breast tissue showing no significant abnormality. No evidence of malignancy is seen.
Specimen C. The lesion is a tubular carcinoma of the breast (infiltrating ductal carcinoma of the breast, grade 1). The tumour is composed of radiating tubular structures lined by cells which show mild to moderate cytological atypia. There is focal coarse microcalcification within some of the tubular structures. The lesion appears to be completely excised by a margin of approximately 2mm. There is a mild lymphocytic inflammatory infiltrate at the periphery of the lesion. No intraduct component is identified. There is possible perineural invasion at one edge of the tumour nodule.

Conclusion: Right breast lump, tubular carcinoma of the breast, local excision close but appears clear of the tumour.

ER: Not known
PR: Not known

 

MANAGEMENT OPTIONS

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RECOMMENDATION

ONCOLOGY OPINION

Initially referred to a medical oncologist and radiation oncologist from an inner city teaching hospital and then to Radiation Oncology Department at Westmead Hospital because of geographic reasons.

Clinical examination - negative apart from 5cm scar in the upper outer quadrant. An axillary dissection was performed and 1/15 nodes were positive.

RECOMMENDATION

Recall histopathology slides and review at Westmead Hospital by specialist breast pathologist

FINDINGS

HISTOPATHOLOGY REVIEW

Microscopic: Sections show infiltrating duct carcinoma grade 1 without a DCIS component.

DIAGNOSIS

Breast: Infiltrating duct carcinoma Grade 1.

MANAGEMENT

Radiation Therapy to the right breast.

Adjuvant CMF chemotherapy.

Last Updated on Monday, 15 February 2010 10:58