Case Report: Lobular Carcinoma in Situ Extended

BACKGROUND: Lobular carcinoma in situ was first described in the 40s. Its incidence is low, representing several studies from 0.5 to 3. 6% of specimens of presumably benign breast biopsies. Usually not palpable on clinical and not have any specific change in mammography. These lesions are recognized tendency to multifocality, and the bilateral occurs in approximately 25% of cases. This report describes a case of lobular carcinoma in situ with unusual features: clinically palpable and extensive. REPORT: GHS, female, 42 years, physical therapist, came to us on 18. 04. 2012 with a history of hardening in the right breast for 2 months. It states that the breast was warmer than the left, but denied hyperemia. Menarche: 12 years old. Childless. PHYSICAL EXAMINATION: Right breast: hard and irregular nodular area in the upper outer quadrant of approximately 5.5 cm x 4. 6 cm and mobile. Most hardened area in the Upper External / Axillary Extension. Armpit Right: level II lymph node slightly hardened. Difficult to assess. Left Breast: mild thickening. Left Armpit: unchanged. ADDITIONAL EXAMS: Mammography (03/22/2012): dense breasts without lesions. Breast Ultrasound (03/22/2012): no suspicious lesions. Magnetic Resonance Imaging (04/20/2012): ill- defined nodular thickening in the upper outer quadrant of right breast measuring approximately 9. 0 cm x 4. 0 cm (BIRADS V). CORE BIOPSY-FREE HAND (04/23/2012 ): Lobular carcinoma in situ involving four quarters of the core pieces (95% sample). Presence of microscopic focus can not be excluded micro invasion. The patient underwent incision biopsy ( 01/05/2012), with very representative fragment. Histopathology examination revealed: Lobular Carcinoma in Situ, confirmed the result after performing immunohistochemistry micro invasion. In the Session Service of Mastology, Hospital Geral de Fortaleza decided to perform skin sparing mastectomy with sentinel lymph node and immediate reconstruction of the right breast. The histopathology of the surgical describes: Lobular Carcinoma in Situ, with suspected area of invasion measuring 1. 1 mm at a depth corresponding to the region upper outer quadrant. DISCUSSION: Lobular carcinoma in situ (LCIS) is usually an incidental finding at surgery performed for other reasons, is not identified because in most cases is not associated with calcifications and does not form a palpable mass. This report describes a case of lobular carcinoma in situ with the clinical pathological features quite different from those described in the literature.