01/05/2010

CLINICAL CASE - MAY 2010

Patient
47 years old, appointment with previous surgical biopsy on the right breast, to clarify clustering of pleomorphic microcalcifications in the upper outer quadrant, away from the nipple-areola complex, revealed by a mammography. Breast sonography - normal.

Pathology Results
High degree of intraductal carcinoma, with lobular cancerization and infrequent points of microinvasion of the stroma. Surgical margins affected at several points.

Physical Examination
Small, flaccid breasts, with slight ptosis and stretch marks and a curved scar on the upper outer quadrant of the right breast. Axilla normal to the touch.

Surgical Plan
Sentinel lymph node, right mastectomy preserving the nipple-areola complex, if the retromammillary transoperational analysis for malign cells is negative. Immediate breast reconstruction with a silicone prosthesis and symmetrization with the contralateral breast.

Trans-operational Procedures
A subtle lesion in the right breast was observed at the time that the points of incision were marked, which had not been noticed beforehand, and had not been seen during the pre-surgical physical examination. This was not visible in the photographs that were re-examined retroactively. An excisional biopsy of the affected area of the breast was carried out: tumor.

Measures Taken
Sentinel lymph node and right mastectomy including the nipple-areola complex. Immediate breast reconstruction with a prosthesis and symmetrization with the opposing breast. Reconstruction of the right nipple-areola complex was put off until a second stage to enable symmetrization with the left breast.

Results of the Post-Operative Anatomical and Pathological Tests
- Sentinel lymph node: Reactive lymphoid hyperplasia.
- Right nipple: Paget’s disease.
- Right breast (mastectomy): In situ intraductal carcinoma: 2.0cm long, open-ended (the lesion lay 0.3 cm away from the skin, 1.0cm from the posterior edge and well away, at least 2.0cm from the other edges).
- Left breast (symmetrization): fibromicrocystic alteration with apocrine metaplasia.
- Negative estrogen and progesterone receivers.

Additional Treatment
Radiotherapy, chemotherapy and hormone therapy not indicated.

Follow-up
Routine reviews and subsequent reconstruction of the right nipple-areola complex.

Read more about Paget’s disease at:
http://www.cancer.gov/cancertopics/factsheet/Sites-Types/pagets-breast

MAKE AN APPOINTMENT

OUR ADRESS

Centro de Cirurgia Reconstrutiva
R. Florêncio Ygartua, 288 / 1004
Bairro Moinhos de Vento
Porto Alegre - RS - Brazil
Fones +55 (51) 3333.9409

http://www.sirleicosta.com.br
sirlei@sirleicosta.com.br