No abstract

No abstract

No abstract

InÞ ltrating duct carcinoma within a Þ broadenomaSir Fibroadenoma may rarely be associated with breast cancer, lobular or ductal carcinoma in situ. [1] Infiltrating duct carcinoma (IDC) arising within a fibroadenoma is exceptional. [2] We report a case of fibroadenoma with coexisting IDC and extensive duct carcinoma in situ (DCIS) in a woman with surgical menopause.A 43-year-old woman underwent hysterectomy and bilateral salpingo-oophorectomy in March 2005, for multiple leiomyomata and ovarian follicular cysts. Subsequently she received conjugated equine estrogen (CEE) tablets, 0.625 mg daily, as hormone replacement. A prior breast ultrasonogram showed multiple asymptomatic, nonpalpable fibroadenomas bilaterally, 8.4 mm to 9.5 mm in diameter. No microcalcification was detected on mammography. A follow-up in 2006 was normal, but an ultrasonogram and mammogram in March 2007, showed a suspicious lump . A core needle biopsy was inadequate. No fine needle aspiration cytology (FNAC) was performed. Hook-wire localization and excision of the lump showed a 1.8 cm, firm, whitish nodule. The surrounding breast tissue was unremarkable and surgical margins were uninvolved. Microscopically, the nodule was circumscribed, with slit-like clefts [ Figure 2a], resembling a fibroadenoma. However, the cells within the slit-like spaces exhibited marked nuclear pleomorphism and prominent nucleoli [ Figure 2b]. There were foci of stromal infiltration by tumor cells [ Figure 2c] and typical duct carcinoma in situ [ Figure 2d], confined only to the nodule. More than 16 mitoses / 10 high-power fields were noted. Oestrogen or progesterone receptors were negative, but C-erb B2 was overexpressed [ Figure 3]. A diagnosis of IDC with DCIS, probably arising from a fibroadenoma, was made.A carcinoma is deemed to arise within a fibroadenoma when the malignant cells are limited Figure 1: a) Ultrasound image showing a lobulated, ill-deÞ ned, hypoechoic mass at the one o'clock position of the left breast, which appeared suspicious; b, c) Mammogram of the left breast in the mediolateral-oblique and craniocaudal views: The arrow and arrowhead indicate a low-density lesion in the left breast with no signiÞ cant microcalciÞ cation