Ductal Carcinoma in Situ of the Breast: A Case Report With an Atypical Clinical Presentation

Abstract

Ductal carcinoma in situ (DCIS) of the breast is a proliferative lesion, precursor of cancer, which has been increasingly diagnosed due to mammographic screening. Tumor size itself does not determine whether the lesion is in situ or invasive, so it is essential to emphasize that DCIS can present with variable extension. We report a case of a 44-year-old female patient that was diagnosed a great (12 cm) DCIS of the breast without microinvasion through pathologic examination. The patient presented with an increase of the right breast, acyclic mastalgia and right bloody nipple discharge. Mammography was inconclusive, the ultrasound suggested inflammation and the incisional biopsy revealed DCIS nuclear grade 3 with compromised lateral margins. It was performed simple mastectomy and axillary node sampling. The clinical presentations of benign and malignant diseases of the breast are variable. The most common symptoms reported by women are pain, palpable mass or nipple discharge. The literature reveals that the extent of this type of cancer is variable, being found in a review intraductal lesions up to 5.4 cm, size smaller than that one that was found in this patient. This finding makes the clinical apresentation interesting to be discussed. Although mammography is the most efficient method to diagnose this injury, clinical breast exam should be performed in all gynecological independent of patient age because it is useful for diagnosing early lesion, considering that it is a palpable lesion.Keywords: Breast cancer; Clinical presentation; Diagnosis. INTRODUCTIONBreast cancer is a common disease among women and in recent decades, has been noticing an increase in incidence and mortality associated with this neoplasm. (1,2,3) According to the Ministry of Health (2012), (1) even being considered as a good prognosis cancer when diagnosed and treated appropriately, mortality from breast cancer still present with high rates in Brazil, probably by the diagnosis in advanced stages (III or IV). The DCIS of the breast involves a heterogeneous group of neoplastic proliferation, non-invasive, with risk of recurrence and malignant transformation. (16) According to Boff and Wisintainer (2006), (17) the increase in the incidence of DCIS is due to mammographic imaging technology that is diagnosing non-palpable breast lesions. They claim that the diagnosis and treatment of non-invasive breast cancer will reduce the mortality rate in up to 46%. In patients adequately treated, the survival rate in 16 years is 95%. (18) DCIS does not invade the lymphatics and blood vessels, therefore, can not spread. It is composed of a population of malignant cells confined to the ducts by the basement membrane. It is therefore a clonal proliferation involving, in general, a single ductal system and the myoepithelial cells are preserved. (19,20) But, may be involved more than one duct or a single duct with more than one target area, separated by parenchyma without lesions. (21) This work aimed to report a case of DCIS of the breast in extensive...