Positron emission tomography-computerized tomography (PET-CT) showed increased F-18 fluorodeoxyglucose (FDG) uptake at both supraclavicular lymph nodes, especially more prominent on the right cervical level. Immunohistochemistry results were as follows: p63 (+) at myoepithelial cells, estrogen receptor (ER) (+) for about 5%-10% of the cells at the ductal carcinoma in situ (DCIS) focus, progesterone receptor (PR) (-) for the cells at the DCIS focus. Pathological examination resulted as: microinvasive breast carcinoma, nuclear grade II. Following radiological examinations showed no residual lesions. Bilateral mammography was reviewed as Breast Imaging Reporting and Data System - 4B for the right breast (possible malignant findings), and therefore excisional biopsy (surgical margin clear of disease) was performed. Cervical smear, endometrial sampling, endoscopy of the gastrointestinal system, routine biochemical tests and complete blood count resulted in the normal range.Īpart from elevated CA15-3 concentration (157 IU/mL) and erythrocyte sedimentation rate (72 mm per 30 min) no abnormal blood parameters were present. Ultrasonography of the upper abdomen and the physical examination of the breast was normal. The lesion, which seemed to be originating from the right ovary was measured to be 65 mm × 72 mm in size. Pelvic ultrasonography of the left adnexa and the uterus was normal regarding the patient’s age. A solid, mobile mass was found at the right adnexal region during gynecologic examination. No other abnormal clinical finding was detected. Systemic examination only demonstrated a palpable lymph node, which was 2 cm × 3 cm in size, at the right supraclavicular region. Due to the finding of a metastatic carcinoma at the lymph node after thin needle aspiration biopsy, she was investigated with imaging and systemic examination in order to find the primary focus. We found it to be interesting, due to the rarity of such cases.Ī 54-year-old patient (Gravida 4, parity 3, 3 years since menopause, gave birth to her last child 20 years ago) was visited due to the complaint of a palpable lymph node at the right supraclavicular region. In this article, we present a case of microinvasive breast cancer that presented clinical findings with supraclavicular lymph node involvement and ovarian metastasis without any findings from breast examination. On the other hand, although there are very few in the literature, there are reported cases of aggressively progressive microinvasive breast cancers that presented clinical findings with lymph node involvement and distant organ metastasis. Lymph node metastasis, which is one of the most important prognostic factors of breast cancer, is rare among microinvasive breast cancers (0%-25%) and there is an expectation of better clinical course. Generally, it is known that their clinical behavior is between invasive carcinoma and carcinoma in situ. The prognosis of microinvasive breast cancer is open for discussion, since it is rare and difficult to diagnose. Later, the World Health Organization defined it as an invasive carcinoma of the breast with no invasive focus measuring more than 1 mm. The term of “microinvasive breast cancer” was used by Logios in 1982. Microinvasive breast cancer makes 0.7%-2.4% of all cases, it is a rare subgroup of breast cancer. Breast cancer is one of the most common cancers and it is often stated as the second cause of cancer related deaths among women. In the United States, one in every eight women has the risk to experience breast cancer in her lifetime.
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