Metastatic “Ductal Carcinoma In Situ–Like” Lobular Carcinoma in a Lymph Node: A Case Report and Review of the Literature

Metastatic breast cancer resembling ductal carcinoma in situ (DCIS) is a rare phenomenon. In this article, we present a unique case of metastatic lobular carcinoma with DCIS-like morphology in the left axillary lymph nodes of a 52-year-old female. She presented with 2 lesions in the left breast on mammography, and a mastectomy with axillary lymph node dissection was performed. Gross examination showed a 3.5 × 2.5 × 1.0 cm indistinct tumor in the lower outer quadrant and a 2.5 × 2.5 × 1.8 cm tumor in the upper outer quadrant. Microscopic assessment revealed a pleomorphic lobular carcinoma in the lower outer quadrant and a grade 2 invasive ductal carcinoma in the upper outer quadrant. Sixteen of the 17 axillary lymph nodes showed metastatic lobular carcinoma with foci of solid and comedo-type DCIS-like features. Immunohistochemical analysis of the primary and metastatic lobular carcinoma showed no expression of E-cadherin and p63 antibodies. To our knowledge, metastatic lobular carcinoma exhibiting this pattern has not been reported. The case suggests that lobular carcinoma can morphologically recreate a primary microenvironment at a distant site and simulate in situ growth. Recognition of this pattern is important to avoid misdiagnosis.

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Ductal Carcinoma In Situ Simultaneously Involving the Breast and Epithelial Inclusions in an Ipsilateral Axillary Lymph Node

International Journal of Surgical Pathology ◽

10.1177/1066896918763899 ◽

2018 ◽

Vol 26 (6) ◽

pp. 564-568 ◽

Cited By ~ 1

Author(s):

Leah A. Commander ◽

David W. Ollila ◽

Siobhan M. O’Connor ◽

Johann D. Hertel ◽

Benjamin C. Calhoun

Keyword(s):

Lymph Node ◽

Ductal Carcinoma In Situ ◽

Axillary Lymph Node ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Disease ◽

Metastatic Carcinoma ◽

Axillary Lymph Nodes ◽

Axillary Lymph

Benign cystic epithelial inclusions with squamous, glandular, or Müllerian phenotypes are known to occur in the axillary lymph nodes of patients with benign and malignant breast disease. Careful evaluation of hematoxylin and eosin–stained slides and correlation with the histologic findings in the ipsilateral breast are paramount in evaluation of suspected benign inclusions. In this case of ductal carcinoma in situ (DCIS) of the breast in a 73-year-old woman, DCIS also involved epithelial inclusions in an ipsilateral axillary lymph node. The recognition of these benign epithelial elements, and awareness that they can be involved by DCIS, is crucial to avoid the overdiagnosis of metastatic carcinoma.

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A Case of Ductal Carcinoma in situ with Swollen Axillary Lymph Nodes Accompanied by Sarcoid-like Reaction

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.77.1891 ◽

2016 ◽

Vol 77 (8) ◽

pp. 1891-1895

Author(s):

Masato SHIZUKU ◽

Yutaka MIZUNO ◽

Yoshiharu NARA ◽

Toshihiro MORI

Keyword(s):

Lymph Nodes ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Axillary Lymph Nodes ◽

Axillary Lymph

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Solitary, Well-Circumscribed, T2 Hyperintense Masses on MRI Have Very Low Malignancy Rates

Journal of Breast Imaging ◽

10.1093/jbi/wby014 ◽

2019 ◽

Vol 1 (1) ◽

pp. 37-42 ◽

Cited By ~ 1

Author(s):

Lars J Grimm ◽

Michael Enslow ◽

Sujata V Ghate

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Breast Mri ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Malignancy Rate ◽

The Masses

Abstract Objective The purpose of this study was to determine the malignancy rate of solitary MRI masses with benign BI-RADS descriptors. Methods A retrospective review was conducted of all breast MRI reports that described a mass with a final BI-RADS assessment of 3, 4, or 5, from February 1, 2005, through February 28, 2014 (n = 1510). Studies were excluded if the mass was not solitary, did not meet formal criteria for a mass, or had classically suspicious BI-RADS features (e.g., washout kinetics, and spiculated margin). The masses were reviewed by 2 fellowship-trained breast radiologists who reported consensus BI-RADS mass margin, shape, internal-enhancement, and kinetics descriptors. The T2 signal was reported as hyperintense if equal to or greater than the signal intensity of the axillary lymph nodes. Pathology results or 2 years of imaging follow-up were recorded. Comparisons were made between mass descriptors and clinical outcomes. Results There were 127 women with 127 masses available for analysis. There were 76 (60%) masses that underwent biopsy for an overall malignancy rate of 4% (5/127): 2 ductal carcinoma in situ (DCIS) and 3 invasive ductal carcinoma. The malignancy rate was 2% (1/59) for T2 hyperintense solitary masses. The malignancy rate was greater than 2% for all of the following BI-RADS descriptors: oval (3%, 3/88), round (5%, 2/39), circumscribed (4%, 5/127), homogeneous (4%, 3/74), and dark internal septations (4%, 2/44). Conclusion T2 hyperintense solitary masses without associated suspicious features have a low malignancy rate, and they could be considered for a BI-RADS 3 final assessment.

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1389 Axillary Staging in Ductal Carcinoma in Situ with Microinvasion: A Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab259.223 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

B Choi ◽

L Jegatheeswaran ◽

V Patel ◽

M Lupi ◽

E Babu ◽

...

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Current Evidence ◽

Secondary Outcome ◽

Axillary Staging ◽

Axillary Lymph

Abstract Introduction Ductal carcinoma in situ with microinvasion (DCISM) is a rare subtype of DCIS, with a foci of tumour cells penetrating through the basement membrane. A conundrum for surgeons is that definitive diagnosis is made upon histological examination of the final specimen. In the UK, there are no specific guidelines on the role of axillary staging in the management of DCISM cases. Method A systematic review was conducted on the databases MEDLINE and Embase using the keywords: breast, DCISM, microinvasion, “ductal carcinoma in situ with microinvasion”, sentinel lymph node biopsy, SLNB, axillary staging was performed. 23 studies were selected for analysis. Primary outcome was the positivity of lymph node metastases; secondary outcome looked at characteristics of DCISM that may affect node positivity. Results 2959 patients were included. Significant heterogeneity was observed amongst the studies with regards to metastases (I2=61%; P < 0.01). Lymph node macrometastases was estimated to be 2%. Significant subgroup difference was not observed between SLNB technique and lymph node macrometastases (Q = 0.74; p = 0.69). Statistical significance was observed between the focality of the DCISM and lymph node macrometastases (Q = 8.71; p = 0.033). Conclusions DCISM is not linked with higher rates of clinically significant metastasis to axillary lymph nodes. Survival rates are very similar to those seen in cases of DCIS. Current evidence suggests that axillary staging in cases of DCISM will not change their overall management. A conscientious multidisciplinary team approach evaluating pre-operative clinical and histological information to tailor the management specific to individual cases of DCISM would be a preferred approach than routine axillary staging.

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