Click on Images for Enlarged View

Findings:Bilateral mammograms obtained show a 1.7 cm lobulated mass in the superior aspect of the left breast on the MLO view only.

Diagnosis:Medullary carcinoma of the breast

Surgery: Lumpectomy and lymph node dissection was performed.

Pathology: 1.6 cm medullary carcinoma, ER/PR negative, aneuploid, Cathepsin-D positive, ERB-2 negative. 30 axillary nodes negative for disease.

Discussion: Medullary carcinoma is a rare cancer of ductal origin, comprising only 2% of all invasive breast cancers. Distinctive features include large size at detection, soft texture on palpation, and mobility due to lack of invasion. The mean age of incidence is 46-54 years. The prognosis is favorable with a 70% ten-year survival rate.

On radiographs the tumor is well-circumscribed or lobulated and may have a partial or complete halo. They may be dense due to hemorrhage. They can be difficult to distinguish from fibroadenomas. Sonographically they are usually hypoechoic due to uniform cellular composition.

Pathologically the tumor appears nodular with lobulated margins. Larger tumors often have central necrosis without calcification. Histologically large cells with basophillic cytoplasm and large nucleii are seen infiltrated by lymphocytes and inflammatory cells. The lymphoplasmocytic response is characteristic and may account for the necrosis.

References:
1. Kopans, D.B. Breast Imaging. 1989 Lippincott, Philadelphia.

2. Dahnert, W. Radiology Review Manual. 1993 W&W, Philadelphia.

Return to Women's Diagnostic Imaging Page