08/02/2010
Large breast mass.
California Hospital Medical Center
50-year-old female with a 10 cm. mass in left breast.
Procedure: U/S guided needle core biopsy.
Cytology: Smears of biopsy core tissue fragments. Pap stain
Diagnosis:
Invasive micropapillary carcinoma.
Discussion:
Invasive micropapillary carcinoma of the breast usually manifests as a firm, immobile mass. Findings on mammography are of a spiculated, irregular or round, high density mass with or without associated microcalcifications. On sonography, the common findings are of a homogeneously hypoechoic, irregular or microlobulated mass with posterior acoustic shadowing or normal sound transmission. Axillary lymph nodes are frequently involved. Although these findings are not specific and may be seen with other breast malignancies, invasive micropapillary carcinoma should be included in the differential diagnosis for breast masses with these imaging features. Also, radiologic findings may help in the histopathologic differentiation of cases that are difficult to diagnose, such as metastatic tumors.
References:
Günhan-Bilgen I, Zekioglu O, Ustün EE, Memis A, Erhan Y. Invasive micropapillary carcinoma of the breast: clinical, mammographic, and sonographic findings with histopathologic correlation. AJR Am J Roentgenol. 2002 Oct;179(4):927-31.
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Comments
Cytology wise, this case is IDC grade II. I can not determine the histologic typing of the IDC based on the cytology. The biopsy is the accurate tool to achieve such goal.
Invasive ductal carcinoma, grade III.
it shows invasive ductal carcinoma (grade 3) with frequent micropapillary feature. Feature of 'conventional' invasive ductal carcinoma can be discernible on left-lower portion on image10.