Presentation
Left palpable breast lump for 3 months. No family history of breast cancer.
Patient Data
There is a well-defined lobulated high-density opacity seen in the left upper mid-region.
The left breast shows a large irregular hypoechoic lesion, with central cystic changes and hyperechoic halo, seen at 11:00 measuring about 4.5 x 3.3 x 3.8 cm, located 2 cm from the skin, and 8 cm from the nipple.
Strain elastography of the lesion showed a red color in most of the lesion reflecting hard tissue (malignant pattern).
Histopathology Report
Histologic type: invasive carcinoma of no special type (ductal) - metaplastic spindle cell carcinoma Histologic Grade (Nottingham Histologic Score): glandular (acinar)/tubular differentiation: 3; nuclear pleomorphism: 3; mitotic rate: 3; overall grade: 3, score (9/9).
Largest invasive focus in this limited biopsy sample: invasive ductal carcinoma: 7.5 mm - metaplastic spindle cell carcinoma: 2 mm; ductal carcinoma in situ: not identified; lymphovascular invasion: not identified; microcalcifications: not identified.
Tumor comment: sections show needle core biopsies featuring wide areas of geographic necrosis, with residual viable solid nests of pleomorphic high-grade epithelial cells. A small fragment shows a malignant spindle cell lesion with pleomorphic nuclei, irregular nuclear borders and brisk mitotic activity including atypical mitoses. A survival phenomenon is noted with tumor cells showing peri-vascular condensation.
Immunohistochemical stains are needed to confirm spindle cell carcinoma nature and rule out squamous cell carcinoma or mesenchymal sarcoma, including AE1/AE3, p63 and vimentin.
Diagnosis (left breast lump, tru-cut biopsy):
Invasive carcinoma of no special type (ductal), with metaplastic spindle cell carcinoma (see tumor comment). Histologic grade 3 (Nottingham histologic score 9/9).
Case Discussion
Invasive ductal carcinoma is the most common type of breast cancer (70-80%). It is an infiltrating and malignant proliferation of neoplastic cells in the breast tissues.
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