Centrally necrotizing breast carcinoma: a rare histological subtype, which was cause of misdiagnosis in an evident clinical local recurrence

Fernando Hernanz,Pilar Alonso-Bartolomé,Irene González-Rodilla

doi:10.1186/1477-7819-10-156

Fernando Hernanz, Pilar Alonso-Bartolomé + Show 1 more

Open Access

https://doi.org/10.1186/1477-7819-10-156

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Abstract

Centrally necrotizing carcinoma is a rare subtype of breast carcinoma, which is characterized by an extensive central necrotic zone accounting for at least 70% of the cross-sectional area of the neoplasm. This central necrotic zone, in turn, is surrounded by a narrow rim of proliferative viable tumor cells. We report an unusual clinical situation in which a patient whose evident breast mass suggested an ipsilateral local recurrence and for which numerous attempts to confirm the histological diagnosis had failed. The patient was treated with a radical mastectomy based on clinical suspicion of breast cancer recurrence after an undesirable delay. In this case, the narrow rim of viable malignant tissue had a thickness of 0.5 to 8 mm, and the centrally necrotizing carcinoma had a central zone with a predominance of fibrosis. The special features of this case led to a misdiagnosis and to an evident clinical local recurrence.

Highlights

Today, in most patients suffering from breast cancer, treatment is implemented with a histologically confirmed diagnosis and without a diagnostic surgical procedure because a representative sample of the tumor is usually obtained by current radiologic technology. In this case, a patient presented with a large breast mass as a clinical form of a breast cancer recurrence and underwent a radical mastectomy based on clinical suspicion of breast cancer recurrence without microscopic confirmation
The mass was diagnosed as a special subtype of invasive ductal carcinoma termed ‘centrally necrotizing carcinoma’ (CNC) [1]
CNC is an uncommon subtype of breast carcinoma which displays the following histological characteristics: it comprises a well-circumscribed unicentric nodule, having an extensive central necrotic zone accounting for at least 70% of the cross-sectional area of the neoplasm; the central zone is surrounded by a narrow rim of proliferative viable tumor cells; and the residual tumor cells show high-grade infiltrating ductal carcinoma, usually accompanied by the component of ductal carcinoma in situ

Summary

Introduction

Background Today, in most patients suffering from breast cancer, treatment is implemented with a histologically confirmed diagnosis and without a diagnostic surgical procedure because a representative sample of the tumor is usually obtained by current radiologic technology. * Correspondence: hernanzf@unican.es 1Department of Surgery, Valdecilla Hospital, Avda Valdecilla s/n, Santander 39008, Spain 2University of Cantabria, Avda, Cardenal Herrera Oria s/n, 39001, Santander, Spain Full list of author information is available at the end of the article despite the numerous attempts that were carried out to obtain some malignant tissue.

Results

Conclusion