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Slide Seminar 08 - Breast Pathology: Differential Diagnostic Dilemmas
Monday, September 18, 2006 14:00 - 17:30
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Moderator:
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Dr. Christopher Elston
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Disclosure:
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In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Slide Seminar) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. Faculty members for this Slide Seminar have indicated they have no disclosures to make.
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Clinical histories are displayed below.
Click on the case numbers to display the text and references for each case.
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- Ductal Carcinoma In Situ
Submitted by: Dr. Jean F. Simpson
A 58 year old woman underwent a stereotactic needle biopsy after suspicious calcifications were identified on a screening mammogram. She had no previous history of abnormal mammograms. (JS)
Case 1 - Slide 1
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- Atypical Lobular Hyperplasia and Focal Lobular Carcinoma In Situ
Submitted by: Dr. Jean F. Simpson
A 55 year old woman had suspicious microcalcifications detected on a screening mammogram. She underwent a core needle biopsy. The submitted slide is from the subsequent segmental mastectomy. (JS)
Case 2 - Slide 1
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- Flat Epithelial Atypia (Atypical Lobular Hyperplasia)
Submitted by: Dr. Laura C. Collins
A 44 year old woman was found to have microcalcifications on a screening mammogram. An excisional biopsy was performed following wire localisation. (LC)
Case 3 - Slide 1
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- Microglandular Adenosis
Submitted by: Dr. Laura C. Collins
A 47 year old woman was noted to have microcalcifications on breast screening mammogram. A wire localised excisional biopsy was performed. (LC)
Case 4 - Slide 1
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- Metaplastic Carcinoma of the Breast
Submitted by: Dr. Gary Tse
Case 5: A 49 year old woman with a history of thyrotoxicosis for two years, presented with an incidental finding of left axillary mass. Palpation showed a large axillary mass about 5 cm, and in the left breast, a cm firm to hard nodule is present in the 6 o'clock position. Mammography showed a 3 cm mass with partially lobulated margin. No calcification was noted. Sonography showed two enlarged lymph nodes in the axilla, measuring about 4 cm each.)
Biopsy, and subsequent mastectomy with axillary dissection was done. 17 of 17 lymph nodes showed metastases. (GT)
Case 5 - Slide 1
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Case 6: 74 year old Chinese woman with a hard right breast lump. (GT)
Case 6 - Slide 1
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- Malignant Phyllodes Tumour
Submitted by: Dr. Puay Hoon Tan
A 44 year old Chinese woman underwent screening mammography in November 2002 which detected left breast microcalcifications and two right breast nodules at 3 o'clock and 9 o'clock. Stereotactic guided mammotome biopsies of the left breast microcalcifications revealed benign fibrocystic changes, while ultrasound guided trucut biopsies of the right breast nodules showed histological features consistent with derivation from fibroadenomas. In August 2003, she presented with an enlarging right breast mass which was surgically excised. The section is from this excised mass. (PHT)
Case 7 - Slide 1
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- Adenomyoepithelioma
Submitted by: Dr. Puay Hoon Tan
A 72 year old Chinese woman presented with recurrent palpable lumps in the right breast. After a fine needle aspiration procedure, the lump was surgically excised. The section is from this excised lump. (PHT)
Case 8 - Slide 1
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- Infiltrative Carcinoma, Atypical Medullary Type
Submitted by: Dr. Jane Armes
A 38 year old woman presented with a self-detected left breast lump. A slight increase in density of the upper inner quadrant of the left breast was noted by mammography. There were no microcalcifications, architectural disturbances or enlarged lymph nodes. Ultrasound showed a solid lesion in the 11 o'clock region, measuring 15 mm. A fine needle aspirate was performed and the patient went on to have a wide local excision of the breast lesion, with sentinel lymph node and left axillary dissection.
The wide local excision specimen consisted of a fibro fatty portion of breast tissue, measuring 45 x 45 x 30 mm. On sectioning a well circumscribed cream nodule measuring 15 mm in maximum dimension was noted. (JA)
Case 9 - Slide 1
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- Infiltrating Carcinoma of the Breast
Submitted by: Dr. Jane Armes
A 29 year old woman noted a lump within the right breast whilst breast feeding her three month old child (she had one other child aged three and a half years). Ultrasound was performed at that time and 'milk cysts' diagnosed. She re-presented five months later, when still breast feeding, with the lump having approximately doubled in size. Her mother had been diagnosed with breast cancer at age 44 years and now (11 years later) her mother has advanced breast cancer. Her grandmother had died at 77 years of 'possible breast cancer'.
Ultrasound now showed a 25 mm lobulated mass with other smaller areas of possible abnormality within the right breast. An FNA of the largest mass was performed, followed by four separate image-directed core biopsies.
The patient went on to have a right modified radical mastectomy and axillary node dissection.
The mastectomy specimen measured 175 x 165 x 35 mm with attached skin and nipple. Three cream lesions were noted on sectioning, including two relatively well defined nodules within the inner upper quadrant and centrally (both 35 mm maximum dimension). The third lesion occurred in the outer lower quadrant and was poorly defined, measuring approximately 10 mm. (JA)
Case 10 - Slide 1
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Case 10 - Slide 2
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- Papillary Carcinoma In Situ (Complex sclerosing papillary lesion with associated DCIS)
Submitted by: Dr. Christopher Elston
Female 59 years. Attended for routine breast screening. A lobulated 22 mm mass was found in the right upper inner quadrant. Clinical assessment probably benign, imaging assessment indeterminate. Ultrasound-guided mammotome biopsy performed. (CWE)
Case 11 - Slide 1
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- Adenoid Cystic Carcinoma of Breast, Solid/Basaloid Subtype
Submitted by: Dr. Christopher Elston
Female 73 years. She was referred to the Breast Clinic with a lump under the right arm. Clinical examination and mammography revealed a suspicious mass in the right breast. Following needle core biopsy a mastectomy and axillary sampling were carried out. The section is from a 13 mm breast lesion. (CWE)
Case 12 - Slide 1
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