Diffuse Breast Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • There are two main groups of diffuse breast cancers:
    • That present as large areas of architectural distortion on the mammogram:
      • One is neoductgenesis
      • The other is a diffusely infiltrating carcinoma:
        • Which makes up approximately 5% of all breast cancers
Bilateral diagnostic mammogram images
  • When the tumor is e-cadherin negative:
    • It is usually called invasive “lobular” carcinoma
  • When it is e-cadherin positive:
    • It is called infiltrating “ductal” carcinoma:
      • The designation based on e-cadherin staining is arbitrary:
        • Because the behavior of diffusely invasive carcinoma is the same regardless of the staining
  • Lacking calcifications and a central tumor mass:
    • These cancers are notoriously difficult to perceive on mammogram:
      • Even when they are large and palpable or when they occur in fatty involuted breasts:
        • However, the associated connective tissue response:
          • Makes this type of cancer quite visible with ultrasound
Hand-held ultrasound image
  • In contrast to diffusely infiltrating cancers:
    • Circular (Image) and spiculated (Image) tumors arising in the terminal ductal lobular units (TDLU):
      • Have bulging, convex contours protruding into the adipose tissue
Lobulated spherical tumor mass
Multifocal stellate invasive breast cancer
  • The solid variety of infiltrating lobular carcinoma:
    • Most probably arises within the TDLU and has a circular / oval shape on breast imaging
  • There are two other variants of invasive lobular carcinoma that arise in the TDLUs:
    • The tubulolobular variant:
      • Is either a unifocal or multifocal spiculated lesion on the mammogram (Image)
    • The alveolar type of invasive lobular carcinoma:
      • Is usually mammographically occult, or it can be seen as a subtle, asymmetric density (Image)
Multifocal spiculated lesion on the mammogram
Mammogram (a) and large format histology (b) alveolar type invasive lobular carcinoma
  • The various forms of invasive lobular carcinoma that develop in the TDLUs and present as localized lesions:
    • Have a significantly better prognosis than the diffusely infiltrating type breast cancer
  • Complex sclerosing lesions:
    • Present mammographically as nonpalpable architectural distortion with no central tumor mass and lucent radiating structures, the so called “black star”:
      • As opposed to cancers originating from the TDLU:
        • Which have a dense central tumor mass surrounded by radiopaque spiculation, giving the impression of looking at a “white star”
  • Malignant phyllodes tumors:
    • Present as large, high density masses:
      • The borders may be circumscribed or ill defined
  • Fat necrosis:
    • Also presents as a hypoechoic, high-density mass
  • References:
    • Tot T. Diffuse invasive breast carcinoma of no special type. Virchows Arch. 2016;468(2):199-206.
    • Tabár L, Dean PB. Teaching Atlas of Mammography. New York, NY: Thieme; 2011.
#Arrangoiz #BreastCancer #BreastSurgeon #CancerSurgeon #SurgicalOncologist #MountSinaiMedicalCenter #MSMC #Miami #Mexico
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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