Ultrasonographic findings for breast carcinoma with osteoclast-like giant cells.

Abstract

A 72-year-old woman visited our department with an enlarged palpable mass which was 2 cm in diameter, painless, and well-demarcated. She had noticed the mass four months earlier. The family history and her past medical history were unremarkable. On arrival, a movable tumor of 2 cm in diameter was palpated in the upper-outerquadrant of the right breast. The ipsilateral axillary lymph nodes were not palpable. The blood chemistry results, including tumor markers, were normal. Mammography revealed a mass with ill-defined borders and higher central density in the right breast (Fig. 1). The tumor was seen by breast ultrasonography (Apilio, Toshiba, Tokyo, Japan) as a low echoic mass, 28 mm 9 24 mm, with ill-defined borders, irregular margins, and internal heterogeneity (Fig. 2). Doppler US (Fig. 3) and power Doppler US (Fig. 4) showed a rich blood flow in the tumor. Contrastenhanced magnetic resonance imaging (MRI) showed the tumor to be highly enhanced with irregular margins (Fig. 5). The time-intensity curve showed an early peak and plateau pattern, suggesting malignancy. Pathological findings from a core needle biopsy revealed an infiltrating ductal carcinoma of the breast. Estrogen receptor (ER) and progesterone receptor (PgR) tests were positive, and the HER-2 score was 0. No metastases were seen in the brain, lungs, liver, bones, infraclavicular lymph nodes, or axillary lymph nodes by computed tomography (CT) and bone scintigram. With a diagnosis of right breast cancer (T2N0M0 = Stage IIA), a right modified radical mastectomy and biopsy of sentinel lymph nodes were performed. According to the intra-operative rapid pathological diagnosis, the sentinel lymph nodes were negative for metastasis. The final pathological diagnosis was an invasive ductal carcinoma (papillotubular carcinoma) with OGCs (Fig. 6). Immunohistochemical analysis demonstrated that the OGCs were CD68 and vimentin positive, but negative for cytokeratin, S-100, and a-smooth muscle actin. The clinicopathological stage, according to the UICC-pTNM classification, was Stage IIA.