PMC5406118_01
(a) Right CC view showing medial invasive cancer and upper outer quadrant microcalcifications suggesting DCIS and (b) contrast-enhanced MRI showing clumped, linear enhancement in the right upper outer quadrant at the site of microcalcifications, suggesting DCIS but shown pathologically to represent LVI.
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In addition, an area of branching, pleomorphic casting calcifications was seen in the right upper outer quadrant, 6 cm away, suspicious for synchronous DCIS (Figure 1(a)). MRI, performed to evaluate extent of disease, showed an enhancing right medial mass and clumped enhancement in the upper outer quadrant, consistent with biopsy pathology (Figure 1(b)). The site originally reported as DCIS appeared unusual in the mastectomy specimen: clusters of malignant cells were detached from the adjacent tissue and the configurations of the neoplastic cells suggested tumor emboli in vascular channels (Figure 1(a) and (b)).
(a) Section (H&E, 40x) shows well-defined spaces filled with neoplastic ductal cells and central comedonecrosis, (b) A higher power view (H&E, 100x) of the neoplastic ductal cells with nuclear pleomorphism, hyperchromasia, moderate amount of cytoplasm with central necrosis, (c) Immunohistochemical stain (CD31, 100x) for CD31 highlights the endothelial cells lining the vascular channels, (d) Immunohistochemical stain (D2-40, 100x) for D2-40 is negative in the same lining cells and (e) immunohistochemical stain (SMMHC, 100x) for smooth muscle myosin heavy chain decorates smooth muscle in the wall.
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No DCIS was identified in this site, next to the primary invasive carcinoma, or elsewhere in the breast (Figure 2(a)-(e)).