Difficulties in diagnosing and detecting non-invasive and invasive breast cancer

Analysis of the clinical case presented

Zhukova Elena Nikolaevna,

a member of the Russian Society of Mammologists, a member of RUSSCO (Professional Society of Oncologists and Chemotherapists), a member of the European Oncological Society ESMO, an oncologist at Medicina JSC (Academician Roitberg Clinic)

Patient L., born 1977

I went to the mammologist for the first time on December 28, 2016 with complaints of shooting pains in the left mammary gland.

According to the survey results:

mammography from 12/27/16 - diffuse fibrocystic mastopathy. Focal education? area of ​​glandular tissue? in the left gland.

Ultrasound of the mammary glands from 26.12.16. In the right mammary gland in the central zone, multiple anechoic formations with smooth, clear contours of a homogeneous structure with dimensions from 5 × 3 mm to 7 × 4 mm are determined. In the left mammary gland in the central zone, multiple structures similar in structure with a diameter of 3 to 8 mm are determined. The skin over the formations is not changed. Ultrasound signs of diffuse fibrocystic mastopathy.

On examination: 9th day MC. The mammary glands are symmetrical, soft. On the left, it is somewhat edematous, heterogeneous, in all sections, a lumpy glandular tissue is palpable, without clear contours. The skin is not changed. No selection.

Control after 3 months is recommended.

Ultrasound of the mammary glands from 05/26/17 - on the right and on the left in the posterior region and the outer quadrants, multiple anechoic formations are determined in size from 5 × 3 mm to 10 × 5 mm (up to 5-6 in each gland), iso / hypoechoic formations with clear smooth contours with an indistinct effect of distal enhancement, avascular with CDC in the outer quadrants on the right with dimensions of 9 × 5 mm and 7 × 4 mm, 5 × 3 mm and 4.5 × 3 mm, on the left - 8 × 4 mm and 6 × 3.5 mm and 4.5 × 3.5 mm (4 on the right, 3 on the left). The skin over the formations is not changed. Ultrasound signs of diffuse fibrocystic mastopathy

On examination: 9th day MC. The mammary glands are symmetrical, soft, somewhat heterogeneous in the outer quadrants, the skin is not changed.

From 07.2017 noted a lump in the left breast.

Ultrasound of the mammary glands from 08/15/17 - multiple anechoic formations are determined on both sides: 15 × 9 mm to the left, 8 × 6 mm to the right. In the left breast for 6 hours. a non-uniform echogenic area with uneven fuzzy contours measuring 31 × 16 × 47 mm, with multiple hypoechoic areas and hyperechoic linear structures. With CDC, they are moderately vascularized. The skin over the formations is not changed. Ultrasound signs of diffuse fibrocystic mastopathy, focal formation of the left breast?

Day 5 MC. The mammary glands are symmetrical, soft. On the left, at the border of the lower quadrants, a dense formation up to 2.5 cm in diameter is palpated, tightening the skin.

08/28/17 - COR-biopsy of the left breast formation.

GDz: fragments of breast tissue with foci of intraductal cancer, NG3 of a solid structure with signs suspicious of microinvasion, "carcinization" of lobules. To reliably exclude invasive growth, immunophenotyping (IHC) is necessary.

Immunohistochemical study: taking into account the immunophenotype, it corresponds to intraductal carcinoma, NG3 with "carcinization" of lobules, without convincing signs of invasive growth in the volume of the studied material.

09/29/17 - operation (RONC) - radical mastectomy on the left.

A planned histological examination revealed no invasive component. Revision in 62 OD and Israel.

GDz:

1. Paget's cancer of the nipple with microinvasion areas to a depth of 0.5 mm.

2. Breast cancer 4 × 3 × 3 cm in situ with areas of microinvasion to a depth of 1-3 mm, in 5 l / nodes without metastases. IHC for the microinvasive component RE-6b, RP-0, HER2-3 +, Ki 80%.

IHC: invasive nonspecific breast cancer, ductal carcinoma In situ Gr3, RE-6b, RP-0, HER2-3 +, Ki more than 20%.

Final diagnosis.

Multiple primary synchronous cancer:

1. Cancer of Paget's nipple on the left St IA T1micN0M0.

2. Cancer of the left breast St IIA T2 (4 cm) N0 (0/5) M0.

Taking into account the presence of an invasive component, the patient underwent systemic therapy: 4 courses of Docetaxel + Cyclophosphamide, 18 injections of Trastuzumab.

Receives hormone therapy Tamoxifen.

Currently, no progression of the disease has been identified.