Multifocal ductal carcinoma in situ presenting with breast discharge and a lump

What happened, in summary

A 52-year-old woman had several months of non-bloody right nipple discharge and a palpable breast lump. Imaging showed 2 complex solid and cystic masses in the right breast, one at the 6 o’clock position and another at 8 o’clock.

Biopsy of the first lesion showed at least ductal carcinoma in situ, grade 2, with a cribriform pattern involving intraductal papilloma tissue. The tumour showed more than 80% estrogen- and progesterone-receptor positivity. Biopsy of the second lesion also showed ductal carcinoma in situ, with solid and cribriform patterns.

She underwent a right total mastectomy with sentinel lymph-node biopsy. Final pathology confirmed grade 2 cribriform ductal carcinoma in situ, with the largest focus in a single block measuring 0.7 cm. Surgical margins were free of tumour and neither of the 2 sampled lymph nodes contained metastasis. Estrogen-receptor expression was greater than 95% on the mastectomy specimen.

She was recovering from surgery at the latest follow-up described. Further discussion about adjuvant endocrine therapy was planned after recovery. The final surgical findings remained confined to ductal carcinoma in situ with clear margins and no involved sentinel nodes.