Palpable multifocal and multicentric invasive lobular breast carcinoma in a young female

Abstract

Breast cancer is the most common carcinoma plaguing women in the United States. Invasive lobular carcinoma is the second most prevalent type of breast carcinoma with an incidence rate of 5% and 15% with high propensity for multifocal manifestation of disease. Multifocal disease is defined by two or more malignant foci within a single quadrant. Invasive lobular carcinoma is strongly associated with early menarche, late menopause, late age at first birth, and is typically seen in women ages 50 and older. Invasive lobular carcinoma can be difficult to detect clinically because lesions typically fail to form palpable masses, and it can be challenging to diagnose mammographically due to subtle imaging features of the lesions. Here we present a rare case of a palpable, unilateral, multifocal and multicentric lobular breast carcinoma in a young, previously healthy 41-year-old woman with no family history of breast cancer.

Keywords: Breast carcinoma; Invasive lobular carcinoma; Magnetic resonance imaging; Mammography; Multifocal lobular carcinoma of the breast; Ultrasound.

Fig. 1

Screening mammogram demonstrating a spiculated mass.

Fig. 2

Diagnostic mammography showing a poorly defined spiculated mass in the upper inner quadrant of the right breast with additional architectural distortion posterior to the mass.

Fig. 3

Ultrasound revealing multiple irregularly marginated, spiculated, hypoechoic masses with associated vascularity highly suspicious for malignancy.

Fig. 4

Subtraction images from patient's breast MRI revealing mass-like and non-mass-like areas of abnormal enhancement in the right breast consistent with patient's known multifocal and multicentric malignancy. No abnormal areas of enhancement that would be suspicious for malignancy were noted in the left breast.

Fig. 4

Subtraction images from patient's breast MRI revealing mass-like and non-mass-like areas of abnormal enhancement in the right breast consistent with patient's known multifocal and multicentric malignancy. No abnormal areas of enhancement that would be suspicious for malignancy were noted in the left breast.