Complex sclerosing lesion of the breast displaying progression to invasive cancer: A case report

Abstract

A 70 year old lady presented with two lumps in the right breast since around fifteen years which were increasing in size since the past one year. Mammography showed a solid-cystic and a lobulated lesion in the right breast which were categorized as BIRADS (Breast Imaging- Reporting and Data System) category 4/5. On FNAC, a diagnosis of Atypical Ductal Hyperplasia, NHSBSP (National Health Service Breast Screening Programme) Category C4 was made and histopathologic examination advised. Subsequently right sided simple mastectomy was received the larger mass in which showed extensive areas of sclerosing adenosis with superimposed ductal carcinoma in situ. The subareolar mass showed a papillary lesion displaying epithelial overgrowth with features compatible with ductal carcinoma in situ. A thorough search revealed invasive nests in the vicinity of the papillary lesion. A diagnosis of Infiltrating Ductal Carcinoma arising in a multifocal complex sclerosing lesion with extensive intraductal carcinoma and intracystic papillary carcinoma was made. This case offers to display a pathologic continuum of sclerosing breast lesions evolving into atypical hyperplasias, intraductal carcinoma and invasive carcinoma. This falls in line with the current thoughts on premalignant nature of sclerosing lesions of the breast.