A 46-year-old woman had a routine screening mammogram that showed new calcifications in the posterior left breast. Image 1: The diagnostic mammogram showed several small punctate calcifications. A 6-month interval follow-up was recommended. The follow-up mammogram showed pleomorphic calcifications spanning 1.5 cm. Three sites of calcifications were biopsied.
The posterior site showed high–nuclear grade ductal carcinoma in situ (DCIS) with comedonecrosis. The DCIS specimen stained positive for estrogen receptor (3+, 90%) and progesterone receptor (3+, 75%). The patient underwent genetic counseling and testing. No known mutations were found, but four variants of uncertain significance were identified in the APC gene. With the superior lesion as the only site of disease, she was an excellent candidate for lumpectomy; however, she opted for bilateral mastectomy and left sentinel lymph…
