CLINICAL HISTORY
A 50-60 year old female with past medical history of with breast-conserving therapy following bilateral breast cancer was found to have suspicious calcifications in her breast on imaging. She underwent a stereotactic guided core needle biopsy of that breast, and her pathology showed the lesion in Image 1A-B. E-cadherin (Image 2) and p120 (Image 3) immunostains were performed. ER and PR were positive with an H-score of 300 and 26, respectively.
Image 1A-B. Breast core biopsy H&E
Image 2, E-Cadherin immunostain
Image 3. p120 immunostain
Webcase March 2023
Female in Her 50s with New Breast Calcifications on Imaging
Abou Shaar, Rand, M.D; Fine, Jeffrey, M.D
Questions:
- What is the diagnosis?
- Atypical ductal hyperplasia (ADH)
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS) (correct answer)
- Atypical lobular hyperplasia (ALH)
- What is the most frequently mutated gene in this entity?
- p53
- CBFB
- PTEN
- CDH1 (correct answer)
- What is the risk of breast cancer following this diagnosis in the general population?
- None
- 1-2 fold increase
- 3-5 fold increase
- 7-10 fold increase (correct answer)
- What would the corresponding FNA findings include?
- Large pleomorphic neoplastic cells forming clusters and some singular in a background of debris and microcalcifications
- Small bland uniform neoplastic cells forming loosely cohesive groups (correct answer)
- Biphasic epithelial and stromal fragments
- What is the first best practice approach when encountering similar solid lesions:
- Perform immunohistochemical stains (correct answer)
- Recommend surgical excision
- Recommend re-biopsy