Multifocal invasive ductal breast cancer with osteoclast-like giant cells: a case report

Abstract

Introduction: To the best of our knowledge, this is the first case report of a multifocal (trifocal) invasive carcinoma of the breast containing osteoclast-like giant cells.

Case presentation: A 64-year-old Caucasian woman presented for routine mammography screening with three radiodense lesions in the lower inner quadrant of the right breast, a primary breast cancer. Microscopic examination showed three foci of invasive ductal carcinoma with multinucleated osteoclast-like giant cells. Osteoclast-like giant cells in breast cancer are a rare phenomenon. They are described in less than two percent of all breast cancers and occur in association with invasive ductal cancer and invasive lobular cancer. In addition, osteoclast-like giant cells have been described in several sarcomas and metaplastic carcinomas of the breast.

Conclusion: To the best of our knowledge, this is the first report of a multifocal infiltrating ductal carcinoma of the breast containing osteoclast-like giant cells. This could be an indication for a possible early event in carcinogenesis associated with a biological event or secretion that indicates the differentiation and/or migration of stromal cells or macrophages.

Figure 1

Digital mammography (mediolateral projection).

Figure 2

Screening mammogram performed two years earlier than 2009.

Figure 3

Craniocaudal spot compression in digital mammogram view focused on the three lesions.

Figure 4

Macrophotography of the greatest focus.

Figure 5

Microphotography (hematoxylin and eosin staining; original magnification, × 200).

Figure 6

Microphotography (hematoxylin and eosin staining; original magnification, × 400).

Figure 7

Immunohistochemical positive reaction of the stromal cells for vimentin (original magnification, × 400).

Figure 8

Immunohistochemical positive reaction with antibody against the estrogen receptor in the tumor cells (original magnification, × 400).

Figure 9

Immunohistochemical positive reaction with antibody against the progesterone receptor in the tumor cells (original magnification, × 400).

Figure 10

Immunohistochemical negative reaction with antibody against human epidermal growth factor receptor 2(HER2)/neu in the tumor cells (original magnification, × 400).

Figure 11

Immunohistochemical positive reaction with antibody against CD68 in the giant cells (original magnification, × 400).