Breast Lesions during Pregnancy - a Diagnostic Challenge: Case Report

Background: Palpable masses of the breast often occur during pregnancy and should be further investigated. The standard diagnostic during pregnancy is an ultrasound combined, if needed, with a core needle biopsy. Most lesions are benign in younger women but, nevertheless, the incidence of pregnancy-associated breast cancer is 1 in 3,000 deliveries and rising. Case Report: We report the case of a 24-year-old patient diagnosed with a palpable breast lesion at 37 weeks of gestation. An ultrasound was performed and the lesion was rated BI-RADS 4. The initial core needle biopsy showed a ductal carcinoma in situ. After delivery and ablactating, a mammography, breast magnetic resonance imaging and a second ultrasound-guided biopsy was performed. Due to the inconclusive imaging and histological results, a wide excision was performed and a juvenile papillomatosis was confirmed. No further resection was necessary as the initial margins were sufficient. Conclusion: This case suggests that the diagnosis of masses of the breast during pregnancy and lactation can be quite difficult. Diagnosis should be confirmed by an excision biopsy and by histological examination through an experienced pathologist. As a significant proportion of papillomas contain malignant regions, an argument exists for the complete excision of all papillary tumours.

Download Full-text

Encapsulated Papillary Carcinoma of the Breast: Imaging Features with Histopathologic Correlation

Journal of Breast Imaging ◽

10.1093/jbi/wbaa068 ◽

2020 ◽

Vol 2 (6) ◽

pp. 590-597

Author(s):

Sarah E Bonnet ◽

Gloria J Carter ◽

Wendie A Berg

Keyword(s):

Papillary Carcinoma ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Breast Imaging ◽

Ductal Carcinoma ◽

Imaging Features ◽

Term Survival ◽

Core Needle ◽

Cystic Component

Abstract Encapsulated papillary carcinoma (EPC) is a rare, clinically indolent breast malignancy most common in postmenopausal women. Absence of myoepithelial cells at the periphery is a characteristic feature. Mammographically, EPC typically presents as a mostly circumscribed, noncalcified, dense mass that can have focally indistinct margins when there is associated frank invasive carcinoma. Ultrasound shows a circumscribed solid or complex cystic and solid mass, and occasional hemorrhage in the cystic component may produce a fluid-debris level; the solid components typically show intense washout enhancement on MRI. Color Doppler may demonstrate a prominent vascular pedicle and blood flow within solid papillary fronds. Encapsulated papillary carcinoma can exist in pure form; however, EPC is often associated with conventional ductal carcinoma in-situ and/or invasive ductal carcinoma, no special type. Adjacent in-situ and invasive disease may be only focally present at the periphery of EPC and potentially unsampled at core-needle biopsy. In order to facilitate diagnosis, the mass wall should be included on core-needle biopsy, which will show absence of myoepithelial markers. Staging and prognosis are determined by any associated frankly invasive component, with usually excellent long-term survival and rare distant metastases.

Download Full-text

Necessity of sentinel lymph node biopsy in ductal carcinoma in situ patients: a retrospective analysis

BMC Surgery ◽

10.1186/s12893-021-01170-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Young Duck Shin ◽

Hyung-Min Lee ◽

Young Jin Choi

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Lymph Node Metastasis ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Ductal Carcinoma ◽

Invasive Cancer ◽

Total Mastectomy ◽

Core Needle ◽

Node Metastasis

Abstract Background Sentinel lymph node biopsy (SLNB) is unnecessarily performed too often, owing to the high upstaging rates of ductal carcinoma in situ (DCIS). This study aimed to evaluate the upstaging rates of DCIS to invasive cancer, determine the prevalence of axillary lymph node metastasis, and identify the clinicopathological factors associated with upstaging and lymph node metastasis. We also examined surgical patterns among DCIS patients and determined whether SLNB guidelines were followed. Methods We retrospectively analysed 307 consecutive DCIS patients diagnosed by preoperative biopsy in a single centre between 2014 and 2018. Data from clinical records, including imaging studies, axillary and breast surgery types, and pathology results from preoperative and postoperative biopsies, were extracted. Univariate analyses using Chi-square tests and multiple logistic regression analyses were used to analyse the data. Results The rate of upstaging to invasive cancer was 19.2% (59/307). DCIS diagnosed by core-needle biopsy (odds ratio [OR]: 6.861, 95% confidence interval [CI]: 2.429–19.379), the presence of ultrasonic mass-forming lesions (OR: 2.782, 95% CI: 1.224–6.320), and progesterone receptor-negative status (OR: 3.156, 95% CI: 1.197–8.323) were found to be associated with upstaging. The rate of sentinel lymph node metastasis was only 1.9% (4/202), and all were total mastectomy patients diagnosed by core-needle biopsy. SLNB was performed in 37.2% of 145 breast-conserving surgery patients and 91.4% of 162 total mastectomy patients. Among the 202 patients who underwent SLNB, 145 (71.7%) without invasive cancer on final pathology had redundant SLNB. Two of 59 patients (3.4%) with disease upstaged to invasive cancer had inadequate primary staging of the axilla, as the rate seemed sufficiently small. Conclusions In patients with a preoperative diagnosis of DCIS, although an unavoidable possibility of upstaging to invasive cancer exists, axillary metastasis is unlikely. Only 2.7% of patients with DCIS undergoing total mastectomy were found to have sentinel lymph node metastases. SLNB should not be performed in breast-conserving surgery patients and should be reserved only for total mastectomy patients diagnosed by core-needle biopsy.

Download Full-text

Diagnosis of an extremely rare pleomorphic adenoma of the breast with core needle biopsy: A case report

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2018.10.037 ◽

2018 ◽

Vol 36 ◽

pp. 242-245

Author(s):

Keiichi Takahashi

Keyword(s):

Case Report ◽

Pleomorphic Adenoma ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Core Needle

Download Full-text

Huge sternal chondrosarcoma: a case report

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318803813 ◽

2018 ◽

Vol 26 (8) ◽

pp. 632-634

Author(s):

Yousef Yousefi ◽

Ali Sadrizadeh ◽

Sepehr Sadrizadeh

Keyword(s):

Computed Tomography ◽

Case Report ◽

Bone Cement ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Muscle Flap ◽

Cartilage Tissue ◽

Prolene Mesh ◽

Core Needle

A 75-year-old man presented very late with a huge sternal mass that measured 91 × 84 mm on computed tomography. A core needle biopsy revealed atypical cartilage tissue, suggesting chondrosarcoma. The mass was resected and the defect was reconstructed with bone cement, Prolene mesh, and a muscle flap.

Download Full-text

Adenomyoepithelioma of the Breast with Hemorrhagic Change Diagnosed as Papilloma on Core Needle Biopsy: A Case Report

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2016.75.5.394 ◽

2016 ◽

Vol 75 (5) ◽

pp. 394 ◽

Cited By ~ 1

Author(s):

Kyungsun Nam ◽

Ji-Young Kim ◽

Soung Hee Kim ◽

Kyung Eun Bae ◽

Ji Hae Lee ◽

...

Keyword(s):

Case Report ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Core Needle

Download Full-text

Ductal Carcinoma in situ after Core Needle Biopsy: In Which Cases Is a Sentinel Node Biopsy Necessary?

Breast Care ◽

10.1159/000502277 ◽

2019 ◽

Vol 15 (3) ◽

pp. 260-264

Author(s):

Robbert J.H. van Leeuwen ◽

Birgitta Kortmann ◽

Herman Rijna

Keyword(s):

Sentinel Node ◽

Sentinel Node Biopsy ◽

Ductal Carcinoma In Situ ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Core Needle ◽

Node Biopsy

Introduction: In some hospitals it is still common practice to carry out a sentinel node biopsy (SNB) if ductal carcinoma in situ (DCIS) is determined in preoperative staging, although this is against international guidelines. The reason for this is because an infiltrative component can be demonstrated frequently in the final pathohistological examination. In this study, we wanted to investigate possible predictors for infiltrative growth, to select patients to do an SNB or to omit it. Material and Methods: All patients with DCIS in the core needle biopsy (CNB), who were treated with surgery including an SNB, were included in a prospective data registry. Patient characteristics were collected through physical examination, mammography and ultrasonography. All characteristics of the DCIS were noted. After surgery, the pathological results were collected. Results: From the 287 patients, 39 (13.6%) had an infiltrative component in the definitive pathological examination despite only DCIS in preoperative CNB. In total, there were only 14 (4.9%) positive SNBs, of which 11 patients had infiltrative growth in the breast tumor and 3 (1.2% of patients with DCIS alone in the final pathology) did not. In addition, characteristics of the CNB, including microcalcifications and comedonecrosis, did not show a statistically significant higher risk for infiltration. Discussion: Considering the low rates of positive SNBs in our population, we think that an SNB should not be performed in advance when DCIS is diagnosed, because if infiltrative growth is found in the final biopsy, an SNB could always be performed afterwards. Only if an SNB cannot be performed afterwards is an SNB indicated.

Download Full-text