Ductal carcinoma in situ of the breast : a case report with an atypical clinical

Ductal carcinoma in situ (DCIS) of the breast is a proliferative lesion, precursor of cancer, which has been increasingly diagnosed due to mammographic screening. Tumor size itself does not determine whether the lesion is in situ or invasive, so it is essential to emphasize that DCIS can present with variable extension. We report a case of a 44-year-old female patient that was diagnosed a great (12 cm) DCIS of the breast without microinvasion through pathologic examination. The patient presented with an increase of the right breast, acyclic mastalgia and right bloody nipple discharge. Mammography was inconclusive, the ultrasound suggested inflammation and the incisional biopsy revealed DCIS nuclear grade 3 with compromised lateral margins. It was performed simple mastectomy and axillary node sampling. The clinical presentations of benign and malignant diseases of the breast are variable. The most common symptoms reported by women are pain, palpable mass or nipple discharge. The literature reveals that the extent of this type of cancer is variable, being found in a review intraductal lesions up to 5.4 cm, size smaller than that one that was found in this patient. This finding makes the clinical apresentation interesting to be discussed. Although mammography is the most efficient method to diagnose this injury, clinical breast exam should be performed in all gynecological independent of patient age because it is useful for diagnosing early lesion, considering that it is a palpable lesion.