Mammographycally occult high grade ductal carcinoma in situ (DCIS) as second primary breast cancer, detected with MRI: a case report

Background: Ductal carcinoma in situ of the male breast is an unusual lesion and most often associated with invasive carcinoma. On rare occasions when the in situ component is present in pure form, histological grade is almost always low to intermediate. Imaging for these patients is difficult as gynecomastia is often present and can mask underlying calcifications or carcinoma. Case Report: We report a case of pure high-grade ductal carcinoma in situ of the male breast in a patient with clear nipple discharge. Breast mammography showed bilateral gynecomastia and benign calcifications. Subsequent breast ultrasound showed dilated ducts of the left breast, and a left breast ductogram showed filling defects suggestive of a papilloma. Excisional biopsy and subsequent mastectomy were consistent with high-grade ductal carcinoma in situ. Conclusion: Male breast cancer is uncommon and, although there is increasing awareness, it is less studied compared to female breast cancer. With a clinical history of nipple discharge of any kind, further evaluation with imaging should be considered. In males with gynecomastia, it is important to remember that ductal carcinoma in situ, even of high grade, is difficult to detect on mammography and may not be associated with suspicious calcifications.

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78. Subcutaneous mastectomy for primary breast cancer or ductal carcinoma in situ

The Breast ◽

10.1016/0960-9776(95)90170-1 ◽

1995 ◽

Vol 4 (3) ◽

pp. 249

Author(s):

K.L. Cheung ◽

R.W. Blamey ◽

J.F.R. Robertson ◽

D.A.L. Morgan

Keyword(s):

Breast Cancer ◽

Ductal Carcinoma In Situ ◽

Primary Breast Cancer ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Subcutaneous Mastectomy

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Grading Ductal Carcinoma In Situ (DCIS) of the Breast – What’s Wrong with It?

Pathology & Oncology Research ◽

10.1007/s12253-019-00760-8 ◽

2019 ◽

Vol 26 (2) ◽

pp. 665-671 ◽

Cited By ~ 2

Author(s):

Gábor Cserni ◽

Anita Sejben

Keyword(s):

Breast Cancer ◽

Clinical Trials ◽

Ductal Carcinoma In Situ ◽

Invasive Breast Cancer ◽

Lower Risk ◽

Carcinoma In Situ ◽

Randomized Clinical Trials ◽

Ductal Carcinoma ◽

High Grade

AbstractDuctal carcinoma in situ of the breast is a non-obligate precursor of invasive breast cancer, and at its lower risk end might not need treatment, a hypothesis tested in several currently running randomized clinical trials. This review describes the heterogeneity of grading ductal carcinoma in situ (DCIS). First it considers differences between low and high grade DCIS, and then it looks at several grading schemes and highlights how different these are, not only in the features considered for defining a given grade but also in their wording of a given variable seen in the grade in question. Rather than being fully comprehensive, the review aims to illustrate the inconsistencies. Reproducibility studies on grading mostly suggestive of moderate agreement on DCIS differentiation are also illustrated. The need for a well structured, more uniform and widely accepted language for grading DCIS is urged to avoid misunderstanding based misclassifications and improper treatment selection.

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Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06129-3 ◽

2021 ◽

Vol 186 (3) ◽

pp. 617-624

Author(s):

Kate R. Pawloski ◽

Audree B. Tadros ◽

Varadan Sevilimedu ◽

Ashley Newman ◽

Lori Gentile ◽

...

Keyword(s):

Ductal Carcinoma In Situ ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Advanced Disease ◽

Breast Conserving Surgery ◽

Risk Profile ◽

High Grade ◽

Group A ◽

First Recurrence

Abstract Purpose Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy. Methods From 2000 to 2016, women with an invasive recurrence occurring ≥ 6 months after initial treatment for DCIS were retrospectively identified. Clinicopathologic features and adjuvant treatment of the initial DCIS, as well as characteristics of first invasive recurrences, were compared between patients who had undergone BCS vs. mastectomy. Results 452 patients with an invasive recurrence after surgery for DCIS were identified: 367 patients (81%) had initially undergone BCS and 85 patients (19%) mastectomy. Patients originally treated with mastectomy were younger and were more likely to have had high grade, necrosis, and multifocal or multicentric DCIS (p < 0.001) compared with the BCS group. A higher proportion of invasive recurrences were local after BCS (93%; 343/367), whereas 88% (75/85) of recurrences after mastectomy were regional or distant (p < 0.001). The median time to first invasive recurrence was not different between surgical groups (BCS: 6.4 years vs. mastectomy: 5.5 years; p = 0.12). Conclusions Among women who experienced a first invasive recurrence after treatment for DCIS, those who had originally undergone mastectomy more commonly presented with advanced disease compared to those treated with BCS, likely related to the absence of the breast and the higher risk profile of their initial DCIS.

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