Ductal Carcinoma in Situ of the Breast: A Case Report with an Atypical Clinical Apresentation

Abstract

INTRODUCTION: Ductal carcinoma in situ (DCIS) of the breast is a proliferative lesion, precursor of cancer, which has been increasingly diagnosed due to mammographic screening. Tumor size itself does not determine whether the lesion is in situ or invasive, so it is essential to emphasize that DCIS can present with variable extension. This type of tumor may manifest as palpable lesion in this way it s necessary to know and to apply methods that allow diagnosis early: self-breast examination, and clinical examination by a trained team. CASE REPORT: We report a case of a 44-year-old female patient that was diagnosed a great (12. 0 cm) DCIS of the breast without microinvasion through pathologic examination. The patient presented with an increase of the right breast, acyclic mastalgia and right bloody nipple discharge. Mammography was inconclusive, the ultrasound suggested inflammation and the incisional biopsy revealed DCIS nuclear grade 3 with compromised lateral margins. It was performed simple mastectomy and axillary node sampling. DISCUSSION: Breast cancer constitutes an important public health problem in world. The clinical presentations of benign and malignant diseases of the breast are variable. The most common symptoms reported by women are pain, palpable mass or nipple discharge. The literature reveals that the extent of this type of cancer is variable, being found in a review intraductal lesions up to 5. 4 cm, size smaller than that one that was found in this patient. This finding makes the clinical apresentation interesting to be discussed. It was decided with the patient by simple mastectomy and axillary node sampling. It was indicated this therapy especially due to tumor extension (12. 0 cm) and necrosis in the lesion. This extension has already predetermined the possibility of shortage of margins. Furthermore the tumor size contraindicated conservative treatment by the close relationship between tumor size and volume of the breast, and often coexist in the same lesion atypical hyperplasia and carcinoma, and carcinoma in situ and invasive carcinoma. The palpable forms of DCIS are associated with multicentricity and occult invasion. Therefore, although the mammography has been considered the most efficient method for early diagnosis of breast cancer, clinical exam should be performed in all gynecological independent of patient age because it is useful for diagnosing early lesion, considering that it is a palpable lesion. For the same reason, the importance of self breast exam should be emphasized during the consultation and the orientation to realize it must be appropriate.