Invasif lobular carcinoma of the breast revealed by an inaugural medullary metastatsis

Abstract

The Invasive Lobular Carcinoma (ILC) represents the second most common histological variant after the Ductal Infiltrating Carcinoma (IDC). The exact clinical aspects of the ILC are controversial. The studies showed a great frequency among menopaused women. The ILC is relatively difficult to diagnose by palpation or mammography because of its imprecise margins. We report the case of 69 years old woman which was presented in clinical hematology consultation for non-regenerative anaemia. Osteomedullar biopsy (BOM) (A,B) showed a rich-infiltrated bone marrow by non-cohesive tumoral cells, generally isolated or forming "Indian file" pattern. Many plasma cells were observed and of broad beaches of small lymphocytes also. Immunohistochemical study to confirm the diagnosis showed: positive staining of tumoral cells with CKAE1/AE3-antibody highlighting the "Indian file" pattern (C). A focal staining with CD138-antibody showing few plasmocytes (D). Nuclear weak and focal staining by the oestrogens-receptor antibody (E). The small reactional lymphocytes indeed were stained with CD5 antibody (F). At last, negative staining with the E-cadherin. Thus, the final diagnosis of medullary invasion by an ILC was retained. The meticulous clinical and Para clinical explorations of the patient were taken again and ended up detecting a left axillar ganglionic cluster with nodule of permeation, whom the histopathological study confirmed the diagnosis. Thus, the patient underwent mastectomy and the later histopathological exam confirmed mammary infiltration by a lobular carcinoma without formation of any macroscopic tumour. These, is an exceptional revelation mode of lobular carcinoma; as far to our knowledge it may be the first reported case.

Keywords

• invasive lobular carcinoma
• medullary invasion