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It is well recognised that breast biopsy procedure can ‘implant’ tumour nests into the stroma such that displaced neoplastic epithelium may be interpreted as invasive carcinoma at subsequent wide local excision or biopsy. Usually the presence of reactive changes abrogates the probability of overdiagnosis of invasive disease. The diagnosis of invasive carcinoma of breast requires great certainty, as there are significant treatment differences between in situ and invasive disease, and the presence of invasion has profound implications for the patient and their families. We write to outline the case of a diagnosed invasive breast carcinoma occurring within a biopsy site that subsequently was shown to be displaced in situ carcinoma that was exceptional in the extent of implanted tumour material spanning 25 mm of excision tissue.
An elderly female presented for investigation of palpable breast lump and bloody nipple discharge. Breast core biopsy was performed and a diagnosis of pure ductal carcinoma in situ (DCIS) was rendered. The patient subsequently underwent a wide local excision. The original pathology reported a 25 mm Grade 1 invasive ductal carcinoma of no special type, arising in a background of extensive intermediate-grade DCIS.