PMC3366477_01
MR image demonstrating a 1.1 cm suspicious enhancing mass at the left breast 1 o'clock axis for which targeted ultrasound was recommended.
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F1
Screening MRI of both breasts performed 15 months later demonstrated interval development of a 1.1 cm enhancing ill-defined mass at the 1 o'clock axis of the left breast (Figure 1).
Targeted ultrasound of the left breast demonstrating a solid hypoechoic lesion at the 1 o'clock axis which corresponded to the enhancing lesion on the MRI.
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F2
A corresponding solid hypoechoic mass with angulated margins was seen on targeted left breast ultrasound (Figure 2).
Digital bilateral mammogram demonstrating heterogeneously dense breast tissue and post surgical changes bilaterally. A microclip is seen at the 1 o'clock axis of the left breast, marking the site of ultrasound guided core biopsy.
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F3
No dominant mass or suspicious clustered microcalcifications were identified in either breast (Figure 3).
Monotonous small cells of lobular carcinoma in situ (thin arrows) show pagetoid extension along ducts with undermining of normal ductal epithelium (thick arrow).
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F4
Extensive histopathologic sampling of the left breast revealed a few foci of lobular carcinoma in situ which was confirmed with a negative E-cadherin immunostain (Figures 4 and 5).
E-cadherin immunostain shows absence of staining in cells of lobular carcinoma in situ (thin arrows) with positive staining in residual benign ductal cells (thick arrow).
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F5
Extensive histopathologic sampling of the left breast revealed a few foci of lobular carcinoma in situ which was confirmed with a negative E-cadherin immunostain (Figures 4 and 5).
Atypical ductal hyperplasia showing hyperchromatic cells with micropapillary type.
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F6
Atypical duct cell hyperplasia, cribriform and micropapillary type was also present in a few foci on the left (Figure 6).
Invasive ductal carcinoma showing a mixture of infiltrating tubules and cords of cells.
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F7
Histopathologic examination of the left breast mass revealed a 1.3 cm well differentiated invasive ductal cancer with a Nottingham Score of 5 of 9, including a tubule score of 2, nuclear pleomorphism score of 2 and mitotic count score of 1 (Figure 7).