Case 1110 - Female in Her 50s with New Breast Calcifications on Imaging

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:

  1. What is the diagnosis?
    1. Atypical ductal hyperplasia (ADH)
    2. Ductal carcinoma in situ (DCIS)
    3. Lobular carcinoma in situ (LCIS) (correct answer)
    4. Atypical lobular hyperplasia (ALH)

 

  1. What is the most frequently mutated gene in this entity?
    1. p53
    2. CBFB
    3. PTEN
    4. CDH1 (correct answer)

 

  1. What is the risk of breast cancer following this diagnosis in the general population?
    1. None
    2. 1-2 fold increase
    3. 3-5 fold increase
    4. 7-10 fold increase (correct answer)

 

  1. What would the corresponding FNA findings include?
    1. Large pleomorphic neoplastic cells forming clusters and some singular in a background of debris and microcalcifications
    2. Small bland uniform neoplastic cells forming loosely cohesive groups (correct answer)
    3. Biphasic epithelial and stromal fragments

 

  1. What is the first best practice approach when encountering similar solid lesions:
    1. Perform immunohistochemical stains (correct answer)
    2. Recommend surgical excision
    3. Recommend re-biopsy

 

 

 

DISCUSSION