Case 258 -- Mass in the Left Breast

Contributed by Deepak Mohan, MD and Dilip Gupta, MD, MIAC
Published on line in January 2001


A 71 year old woman was diagnosed to have a density on a left breast mammogram. The mass doubled in size over the course a year and became palpable. A wide area excision was performed. Examination of the tissue showed a 1.2 cm moderately differentiated adenocarcinoma with mucin production. The tumor extended upto the surgical margins. DNA analysis of the tumor showed diploid population with 1% DNA index (Figs. 1a, 1b, 1c) Estrogen and progesterone analysis by biochemical analysis were 8 fmol/mg and 3 fmol/mg, respectively, and both were interpreted as negative. The tumor did not show Her-2/neu overexpression on immunohistochemistry. A wide local excision with axillary dissection was done the after one month and a biopsy cavity with no residual tumor was identified. All lymph nodes were negative for metastatic carcinoma. Two years later, she developed a 2.5 cm round oval mass in the left breast ( 4 o'clock position). The ultrasound prediction of the mass was hematoma (Fig. 2) The fine needle aspiration showed atypical papillary clusters (Figs. 3, 4). The tissue confirmation was suggested to rule out malignancy. One month later, fine needle aspiration was repeated with similar cytological findings. Incisional biopsy of the left breast lesion was performed after four months. On month later, left total mastectomy was performed.



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