Human epidermal growth factor receptor 2-positive microinvasive breast carcinoma with a highly aggressive course: a case report

Abstract

BackgroundMicroinvasive ductal carcinoma in situ of the breast is a rare entity defined as ductal carcinoma in situ with invasive foci measuring no more than 1 mm. In general, the outcome is excellent, similar to ductal carcinoma in situ. We report a patient with breast ductal carcinoma in situ with microinvasion who died eight months after diagnosis due to progression of the disease – liver metastases. This is the first report in the literature of such an aggressive course.Case presentationA 47-year-old Caucasian woman presented with mammographic-detected suspicious microcalcinations in an area of 8.6 x 6 cm. A radical mastectomy with a sentinel lymph node biopsy and immediate breast reconstruction with implant was performed. A histopathological report showed a massive high grade ductal carcinoma in situ, of the solid and comedo type. In one quadrant, some foci of microinvasions of less than 1 mm were present. Tumour margins were free. Isolated tumour cells were found in the sentinel lymph node. Hormone receptors were negative and human epidermal growth factor receptor-2 status was not performed. The patient received no adjuvant systemic therapy. Eight months after the surgery, she died from hepatic failure without known breast cancer progression before. An autopsy revealed diffuse liver metastases with human epidermal growth factor receptor 2-positive, hormone receptor negative breast cancer. Dissemination to other organs was not proven.ConclusionOur patient is a rare case of ductal carcinoma in situ with microinvasion that developed distant metastases very early. In case of multiple foci of microinvasion, besides radical local treatment we suggest considering adjuvant systemic treatment based on biological characteristics since tumour size alone does not predict the prognosis well.

Analysis of tumour-infiltrating lymphocytes reveals two new biologically different subgroups of breast ductal carcinoma in situ

“…Several authors have reported a very good prognosis of miCa [ 37 – 39 ], whereas others have stressed the clinical problem of local recurrences which would need prevention by large surgical excisions and adjuvant radiotherapy [ 40 , 41 ]. Recently a fatal systemic progression of HER2+ miCa has been reported [ 42 ] implying that search for microinvasion foci in a DCIS lesion, especially of the HER2+ subtype, should be performed as carefully as possible. Our finding of significant similarities between lyDCIS and miDCIS suggest that denser TILs (≥30%) in a DCIS lesion should be evaluated, in larger series, as an indicator of invasion.…”

Incidence, characteristics, and management of recently diagnosed, microscopically invasive breast cancer by receptor status: Iowa SEER 2000 to 2013

“…13 A recent case report describes a patient with HER2-positive MIBC who developed a rapid fulminant distance recurrence within months of initial diagnosis. 14 Previous reports on MIBC treatment and outcomes are largely single institutional and span the pre-trastuzumab era.…”