Case Report: Breast Ductal Carcinoma in Situ Measuring 12cm

Abstract

INTRODUCTION: It is defined ductal carcinoma in situ (DCIS) lesions as characterized by the presence of tumor cells confined to the ducts of the breast with no evidence by light microscopy of invasion of the basement membrane. Estimates suggest that this corresponds to 25% to 56% of new cases of breast cancer detected by screening mammography, knowing that the most common presentation of DCIS is in the form of non-palpable lesions with microcalcifications grouped and heterogeneous. DCIS is a risk factor for invasive carcinoma because not all will develop into an invasive form, and the high-grade lesions that present the greatest risk. The average size of DCIS, according to the literature, ranging between 2 mm and several inches (4 cm on average). This paper aims at presenting an unusual case of DCIS 12cm in greatest diameter. REPORT: Female patient, 37 years, nulliparous, sought service mastology Liga Norte Riograndense contra o cancer- LNRCC on 24/05/2012 referring lump in right breast for 10 months, painless and no history of trauma. Negative family history of cancer. Physical examination revealed large breasts with large lump occupying the entire lateral and medial upper quadrant of the right breast. Normal left breast. Lymph node palpable hardened and mobile level 2 right armpit. Supra and infraclavicular fossae free. Mammography: bodies with dense breast density and oval hyperdense intermingled in both breasts (BI- RADS 0). Breast ultrasonography: lump in right breast at 12, 1. 7 cm, hyperechoic associated with increased consistency in the lateral and medial upper quadrant of the right breast. FNA: positive for malignant cells consistent with ductal carcinoma. A core biopsy showed moderately differentiated intraductal carcinoma. On 8/6/2012 underwent modified radical mastectomy for Madden right which confirmed anatomical and pathological DCIS high grade with an area of ??12cm and axillary contents (14 nodes) without evidence of metastasis. Evolved in the postoperative period was uneventful. DISCUSSION: As pathological prognostic factors of evolution are considered DCIS nuclear grade, histologic subtype, presence of necrosis, extent of free surgical margins and lesion size, the latter being important prognostic factor directly related to the chance of local recurrence. Another factor related to tumor size is the risk microinvasion, which is more common in high grade DCIS and larger dimensions (diameter greater than or equal to 3 cm). The reason for this report is to present an unusual case of DCIS large and high grade not associated with microinvasion.