A huge invasive ductal carcinoma of the left breast

An 81-year-old woman presented with a huge mass of the left breast, with about the size of quail egg four years ago and enlarged gradually in the following years. Physical examination showed a large tumor, approximately 14 cm in maximal dimension, occupied the entire left breast without any pain or nipple discharge (Figure 1). Contrast-enhanced CT scanning revealed the tumor was heterogeneous with solid and cystic components and calcifications, and with uneven enhancement (Figure 2). There were no axillary nodes. The woman underwent modified radical mastectomy, microscopic examination confirmed the diagnosis of an invasive ductal carcinoma (T4aN0M0, Stage IIIA), associated with large areas of necrosis and cystic component, and involved the subcutaneous tissue (Figure 3). Further immunohistochemical examination showed the lesion was ER(-), PR(-), C-erbB-2(+++), P53(-) and the positivity of cell proliferation marker Ki67 was less than 20%. The patient recovered well after operation with adjuvant therapy and she remained free from recurrence after 6 months of clinical observation. Invasive ductal carcinoma is the major type of breast malignancy, usually occurred in premenopausal woman. The combination of surgical resection and the adjuvant therapy such as endocrine therapy or chemotherapy remain the main treatment method.

Figure 1 Gross examination showed a 14 cm × 11 cm × 8 cm mass occupied nearly the entire left breast

Figure 2 Axial enhanced chest CT image reveals a solid and cystic mass with calcification (arrow) and ill defined border

Figure 3 Pathological results (H&E stain ×100) demonstrate large areas of necrosis and cystic degeneration (arrow)

Acknowledgements

Disclosure: The authors declare no conflict of interest.