PMC4899574_01
65-year-old female with granulatomous inflammation and invasive ductal breast carcinoma. Before ultrasound-guided needle localization for lumpectomy, targeted left-breast ultrasound focusing on 6 o'clock was performed (A: transverse view; B: longitudinal view). Ultrasound demonstrated an irregular hypoechoic mass, taller than wide, with ill-defined margins at 6 o'clock, 5 cm from the nipple, measuring 8 x 4 x 6 mm. This finding was consistent with biopsy-proven invasive ductal carcinoma done in an outside facility.
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Although the mammogram was negative with dense parenchyma, ultrasound demonstrated a suspicious mass in the area of the palpable abnormality at 6 o'clock in the left breast (Figs. 1A and 1B) and an enlarged, abnormal-appearing lymph node in the left axilla (Figs. 2A and 2B).
65-year-old female with granulatomous inflammation and invasive ductal breast carcinoma. Microscopic examination of the lumpectomy (Hematoxylin and eosin stain, 200X magnification) revealed infiltrating tubules and solid nests of neoplastic cells, diagnostic of grade II invasive ductal carcinoma.
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Lumpectomy demonstrated invasive ductal carcinoma (Fig. 3) with negative sentinel lymph node.
65-year-old female with granulatomous inflammation and invasive ductal breast carcinoma. Microscopic examination of the left axillary lymph node (Hematoxylin and eosin stain, 200X magnification) showed a coalescent aggregate of epitheloid histiocytes (within black circle) with a central region of necrosis (black arrow), diagnostic of necrotizing granulomatous inflammation.
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Pathological evaluation of the enlarged left axillary lymph node demonstrated necrotizing granulomatous inflammation (Fig. 4), with no evidence of metastatic disease.