Medical Case Reports

Lobular carcinoma in situ with necrosis – does this indicate an underlying carcinoma?

8^th Edition of International Conference on Clinical and Medical Case Reports
May 28-29, 2018 London, UK

Kirupakaran Silas Arun

University of Cambridge, UK

ScientificTracks Abstracts: Med Case Rep

DOI: 10.21767/2471-8041-C1-002

Abstract

Background: Lobular carcinoma in situ (LCIS) is an unusual lesion of the breast that is a neoplasia rather than a carcinoma. Almost all cases of LCIS lack any pleomorphism or necrosis. A PubMed library search into cases of LCIS with necrosis found one valid result, which documents just 18 cases of LCIS with necrosis from the recent databases of six tertiary institutions in the US. When immunohistochemistry confirms LCIS with necrosis, the management plan shifts away from watchful waiting and more towards surgical intervention.

Case report: We report the case of a 43-year-old lady who presented with a right breast mass. An initial mammogram showed some microcalcification fibrocystic changes. Subsequent histology and immunohistochemistry confirmed LCIS with necrosis. Due to the atypical finding of necrosis in conjunction with LCIS, a decision was made to perform further random core biopsies. This confirmed a more sinister underlying mixed lobular and ductal type carcinoma. Reassuringly, US and MRI excluded involvement of the other breast and metastatic disease. A nipple sparing mastectomy and sentinel lymph node biopsy plus immediate reconstruction on the right side was performed followed by adjuvant tamoxifen. 12 months on, the patient is well with no complications.

Conclusion: This case highlights the importance of utilising multiple diagnostic techniques and a prudent histologic examination when a breast lump is in question. LCIS associated with necrosis is rare, but should raise suspicions of an underlying cancer. One way of investigating this would be to perform further random core biopsies and other modalities of investigation with a view to finding further cancer.

Biography

Kirupakaran Silas Arun is an FY1 in General Surgery working at Whipps Cross Hospital in London. He graduated from University of Cambridge with a distinction (ranked 2nd in his year) and he intercalated in Pharmacology and achieved a 1st class degree, being ranked 5th of all students. He has a keen interest in medical education. At the age of 18, he became the youngest UKCAT & BMAT tutor for Kaplan Test Prep and admissions, and was appointed as Lead Tutor for UKCAT & BMAT in 2013. In 2015, he established his own company ‘Easy Medical Interviews’ that provides live and online courses for prospective medical students. Over the last five years, he has helped over 1500 students get into medical school whether it be through UKCAT/BMAT tutoring, polishing and refining personal statements or providing mock interviews. In the future, he intends to pursue a career in Ophthalmology, whilst being heavily involved in academic research and medication education.

E-mail: arunkiru@doctors.org.uk