Case 2

Clinical history

A 54 year old female attended for her first mammographic screen. A spiculate parenchymal deformity was identified in the lower outer quadrant of the right breast. The lesion was impalpable. NCB showed part of a sclerosing lesion with no overt evidence of malignancy.

Triple approach summary

Imaging - Category A
Clinical - not relevant
Histology - uncertain malignant potential B3

Management

In view of the suspicious imaging appearances, excision of the lesion is mandatory, despite the absence of definite malignant histological features. A diagnostic wire guided excision biopsy was therefore performed.

Histological appearances - A-C

Initial sections confirmed a complex sclerosing lesion with florid usual epithelial hyperplasia and foci of low grade ductal carcinoma in situ. Further blocks were taken and in one a 3 mm focus of invasive carcinoma, ductal NST, grade 2, was identified.

Further management

Re-excision of biopsy site - clear margins obtained. Axillary sampling - all four nodes negative.

Final Diagnosis

Complex sclerosing lesion with associated in situ and invasive carcinoma.

Learning points

· All mammographic parenchymal deformities must be excised.
· Value of adequate tissue sampling in excision specimens.