1 Angela Kempen February Case Study February 22, 2012 3D Conformal Radiation Therapy for Mucinous Carcinoma of the Breast History of Present Illness: JE is a 45 year-old Caucasian female who underwent a regular scheduled screening, which led to the detection of a right breast cancer. She had a screening mammography that defined an 8 millimeter (mm) irregular density in the right breast at 6 o’clock posterior depth. She was referred to the Breast Center. The lesion was non-palapable. When a diagnostic mammography was performed, an irregular 13 mm focal asymmetrical density with an indistinct margin was seen in the right breast at 6 o’clock posterior depth. On ultrasound, there was a subtle area of vertically oriented irregular hypoechogenicity in the 6 o’clock location, 7 centimeter (cm) from the nipple corresponding to the mammographic density. She had a vacuum-assisted biopsy, with clip placement, that same day. The pathology returned as benign breast tissue with nerve bundles. The surgeon met with the patient and discussed options for management considering this could be benign, breast malignancy, or a different soft tissue malignancy. She elected to have an excisional diagnostic biopsy. During the biopsy, the
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Angela Kempen
February Case Study
February 22, 2012
3D Conformal Radiation Therapy for Mucinous Carcinoma of the Breast
History of Present Illness: JE is a 45 year-old Caucasian female who underwent a regular
scheduled screening, which led to the detection of a right breast cancer. She had a screening
mammography that defined an 8 millimeter (mm) irregular density in the right breast at 6 o’clock
posterior depth. She was referred to the Breast Center. The lesion was non-palapable. When a
diagnostic mammography was performed, an irregular 13 mm focal asymmetrical density with
an indistinct margin was seen in the right breast at 6 o’clock posterior depth. On ultrasound,
there was a subtle area of vertically oriented irregular hypoechogenicity in the 6 o’clock location,
7 centimeter (cm) from the nipple corresponding to the mammographic density. She had a
vacuum-assisted biopsy, with clip placement, that same day. The pathology returned as benign
breast tissue with nerve bundles. The surgeon met with the patient and discussed options for
management considering this could be benign, breast malignancy, or a different soft tissue
malignancy. She elected to have an excisional diagnostic biopsy. During the biopsy, the
surgeon felt a suspicious lump and converted the procedure to a formal lumpectomy. The
lumpectomy demonstrated a 1.3 cm, grade 1, mucinous carcinoma with 1 cm of intermediate
grade ductal carcinoma in situ (DCIS). No peritumoral intralymphatic tumor emboli were found.
The anterior invasive tumor margin was 2 mm, inferior margin was 4 mm, and all others < 10
mm. Margins for the DCIS were 6 mm anterior and all other margins were < 10 mm. The tissue
was estrogen receptor (ER) 3+ and progesterone receptor (PR) 3+. The patient was staged with a
T1c N0 M0 mucinous breast carcinoma. She was referred to medical and radiation oncology for
further management.
Past Medical History: The patient has mild acne. She has a long smoking history. No
significant history of alcohol use. The patient has no previous history of previous malignancies
or radiation.
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Diagnostic Imaging Studies: The patient had a diagnostic mammogram which identified a 13
mm abnormality at 6 o’clock in her right breast. She underwent a subsequent ultrasound with
abnormal findings correlating to the mammographic finding. A vacuum-assisted needle biopsy
identified benign breast tissue with nerve bundles. She underwent a right axillary sentinel lymph
node biopsy. A surgical excision was recommended. She underwent a needle-localization open
lumpectomy, where a suspicious lump was noted. The procedure was converted from a
diagnostic excisional biopsy to a formal lumpectomy, in which the surgeon took extra tissue and
performed margin assessment. She had chest x-rays to evaluate any possible metastasis.
Family History: The patient has a significant family history. Her mother was diagnosed with
breast cancer at age 38, colon cancer at age 59, and lung cancer at 64. She is deceased at age 67.
Additionally, her grandmother’s sister was diagnosed with breast cancer at a young age. The P53