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LETTER TO THE EDITOR
Year : 2014  |  Volume : 51  |  Issue : 4  |  Page : 424
 

Multicentric synchronous ductal and mucinous carcinoma in ipsilateral breast: An unusual presentation


1 Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India

Date of Web Publication1-Feb-2016

Correspondence Address:
A Riti
Department of Pathology, Sir Ganga Ram Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175339

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How to cite this article:
Riti A, Prem C, Rajeev A. Multicentric synchronous ductal and mucinous carcinoma in ipsilateral breast: An unusual presentation. Indian J Cancer 2014;51:424

How to cite this URL:
Riti A, Prem C, Rajeev A. Multicentric synchronous ductal and mucinous carcinoma in ipsilateral breast: An unusual presentation. Indian J Cancer [serial online] 2014 [cited 2019 Dec 6];51:424. Available from: http://www.indianjcancer.com/text.asp?2014/51/4/424/175339


Sir,

Carcinoma breast, rarely, can present as multicentric or multifocal tumors. However, no uniform definition for these existed. Fisher et al.[1] defined multicentricity as the presence of at least one clinically or mammographically evident tumor in a different quadrant of breast from the index lesion; and multifocality as the presence of more than one distinct focus in a given quadrant. The reported frequency of multicentric mammary carcinomas (MMC) varies from 6% to as high as 75%.[1] Invasive ductal carcinoma (IDC) not otherwise specified, is one of the most common MMC. However, IDC and its variants presenting as separate discrete tumors in the same breast have been only rarely described. We report a unique case of multicentric carcinoma.

A 60-year-old woman presented with two painless lumps in left breast of 1 month duration. Physical examination demonstrated 2 cm firm mass superior to nipple and in lower outer quadrant of left breast. Bilateral mammogram revealed three well-defined radio-opaque densities in left breast: Two in lower outer quadrant and one superior to nipple [Figure 1]. However, on gross examination of the left modified radical mastectomy specimen, one of the nodules in lower outer quadrant was found to be a focus of only nodular fibrosis. Tumor nodules measured 1.6 cm × 1 cm and 1.3 cm × 0.8 cm, each, situated 10 cm apart, in superior and lower outer quadrant of breast respectively. The larger nodule was grey-white, glistening and mucoid while smaller was grey-white and firm. Microscopic examination revealed pure mucinous [Figure 2]a and IDC [Figure 2]b in larger and smaller nodules respectively. No foci of ductal carcinoma in situ were seen. Nine of twenty six axillary lymph nodes showed metastasis by ductal carcinoma.
Figure 1: Left mediolateral view of mammogram showing three radio-opaque densities in the breast. One nodule (arrow) was a focus of nodular fibrosis

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Figure 2

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Multicentricity with mucinous carcinomas has been sparingily described.[2],[3],[4] Synchronous MMC is a challenging issue, when occurring in an ipsilateral breast. Lagios et al.,[5] defined multicentricity as two lesions separated by at least 5 cm of uninvolved breast parenchyma. The two tumor nodules in our case were 10 cm apart. It has been suggested that MMC may arise either from monoclonal proliferation of a single primary carcinoma or are multiple independent primary tumors arising in separate progenitor cells. Increased emphasis on the genetic profile of these tumors helps in better understanding of the disease process in MMC patients and thereby establishing more tailored treatment protocols.

 
  References Top

1.
Fisher ER, Gregorio R, Redmond C, Vellios F, Sommers SC, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol no. 4). I. Observations concerning the multicentricity of mammary cancer. Cancer 1975;35:247-54.  Back to cited text no. 1
    
2.
Gelber CN, Scott MR. Ipsilateral synchronous ductal and colloid breast carcinomas with mammographic correlation. Australas Radiol 1992;36:330-1.  Back to cited text no. 2
    
3.
Nakamura R, Song JP, Isogaki J, Kitayama Y, Sugimura H. Multiple (multicentric and multifocal) cancers in the ipsilateral breast with different histologies: Profiles of chromosomal numerical abnormality. Jpn J Clin Oncol 2003;33:463-9.  Back to cited text no. 3
    
4.
Dawson PJ, Baekey PA, Clark RA. Mechanisms of multifocal breast cancer: An immunocytochemical study. Hum Pathol 1995;26:965-9.  Back to cited text no. 4
    
5.
Lagios MD. Multicentricity of breast carcinoma demonstrated by routine correlated serial subgross and radiographic examination. Cancer 1977;40:1726-34.  Back to cited text no. 5
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