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Case of the Week #236

14 March 2012 - Case of the Week #236

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Thanks to Dr. Jamie Shutter, East Carolina University Brody School of Medicine, North Carolina (USA), for contributing this case and part of the discussion. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.


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Case of the Week #236

Clinical History:

A 71 year old woman with invasive breast cancer underwent a mastectomy and sentinel lymph node excision.

Micro images:

Mastectomy
       

Sentinel lymph node
   

What is your diagnosis?































Diagnosis:

Invasive ductal carcinoma, poorly differentiated, with central necrosis, resembling comedo DCIS

Discussion:

The microscopic images show large areas of atypical cells with central comedo-like necrosis that mimics DCIS. However, these are actually large foci of invasive cancer. In some images, typical invasive carcinoma is present at the edge of the mass and within the lymph node. The lymph node was entirely replaced by tumor of the same morphology.

These cases are difficult on biopsy because they resemble DCIS and the juxtaposed typical invasive tumor may not be present. A key to the diagnosis is the presence of tumor of identical morphology in the lymph node. For determining tumor maximum dimension in T staging, it is important to include DCIS-appearing tumor as invasive carcinoma (J Med Case Reports 2007 Sep 8;1:83).

The differential diagnosis includes central acellular carcinoma, which has one large foci of central necrosis. As noted above, DCIS is also in the differential.


Nat Pernick, M.D., President
and Liz Parker, B.A., Associate Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com