Invasive Ductal Carcinoma with Tumor Necrosis

Clinical History: An 81-year-old female was admitted to the hospital with a chief complaint of shortness of breath.

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Image 1: Note the pleural fluid filling the right lung and circumscribed mass in the right breast.

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Image 2: Mammogram revealed a radiopqaque lesion lower inner quadrant of the right breast. BIRADS 0, radiologist requested ultrasound for further evaluation.

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Image 3: Ultrasound revealed a cystic lesion in the right breast at the five o’clock position, 2 cm away from the nipple.

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Image 4: Due to the cystic nature of the mass, eight core samples were taken to ensure a more accurate diagnosis.

A chest CT with contrast revealed a large loculated right pleural effusion with complete collapse of the right lung. The left lung contained multiple scattered nodules and enlarged hilar lymph nodes. There was a lesion in the right breast measuring 3.4 x 3.6 cm.

A week later a thoracentesis revealed adenocarcinoma in the pleural fluid.

The next day the patient received her first mammogram followed by an ultrasound-guided biopsy of the right breast. Physical examination the day of the biopsy showed a large, palpable mass that was rigid to the touch. The skin appeared red above the mass.

Findings:
The lab report from the biopsy samples indicated that this was invasive ductal carcinoma with tumor necrosis, grade III. Two days later the patient underwent surgery for the placement of a port. Post operative diagnosis concluded that this was right-sided metastatic breast carcinoma with malignant pleural effusion.