Medullary carcinoma is rare and distinct subgroup of breast carcinomas accounting for less than 5% of all invasive breast cancers [1]. The 2012World Health Organization (WHO) up dated the classification of medullary carcinoma under an umbrella term ''carcinomas with medullary feature'', which includes atypical Medullary carcinoma and invasive carcinoma of no special type with medullary features [2]. The diagnosis of medullary carcinoma is usually defined by histologic diagnostic criteria proposed by Ridolfi [3]. Histologically medullary carcinoma demonstrates syncytial growth pattern of poorly differentiated tumor cells with a high mitotic rate. prominent lymphocytic infiltrates with circumscribed microscopic appearance of desmoplastic inflammatory reaction involving mainly the periphery was also diffusely present throughout the substance of the tumor-this is another characteristic feature, which may account for its clinical and biological behavior. Recent publications of breast cancer classification base on gene expression profile analyses indicate that medullary breast carcinoma can be consider part of basal -like carcinoma spectrum made up of estrogen receptor ER negative, progestogen receptor PR negative Her-2/neu negative (triple negative phenotype) [4]. However, there are also publication in which one my find that some MBC and atypical MBC are ER, PR and or. Her-2 positive, indicating the heterogeneity of this type of breast carcinomas [5,6]. The prognosis of MBC is still under dispute. Some studies have reported that survival rates do not differ from those of IDC [3,7]. Most published study have reported lower incidence of axillary lymph node involvement in patients with medullary carcinoma (19% to 46%) than those with atypical medullary carcinomas (30% to 52%) or invasive ductal carcinomas (29% to 65%) [8,9]. Some authors have shown that patients with medullary carcinoma of the breast with positive lymph nodes have 10year overall survival lower than those with N0 nodal disease (58.8% versus 97.1%) [10]. The 5-year survival rate for medullary carcinoma is approximately 78%. Death secondary to this disease is only 10% though. The 20year disease free survival for stage I and II patients are approximately 95% and 61% respectively [10].

According to WHO over 1.2 million women are diagnosis with breast cancer annually worldwide. Infiltrating ductal carcinoma is abroad entity which comprise of tumor that exhibit one or more characteristics of specific types of breast cancers. There is evidence of tubular, papillary, medullary or mucinous differentiation microscopically [3]. It has a predilection for women of younger age group and in a study by Rosen [12] it was found to constitute 11% of all breast malignancies among aged35 and younger. In gross appearance these lesions are well-circumscribed, soft and tan -brown to grey tumors that bulge above the cut surface of the specimen. A multinodular appearance may be appreciated in some spectrum (ER. PR and HER-2negative with high proliferative MIB-1) and apoptotic activity (P53) [4]. The prognosis of medullary carcinoma is better than invasive ductal carcinoma but like another invasive ductal carcinoma it depends on the tumor stage. Based on several studies done previously, medullary carcinoma of the breast is usually described as an irregular shaped mass with micro- lobulation and least frequently with posterior acoustic shadowing sonographically [13]. Calcification is usually not present on mammographic imaging as our case report, so sonographic features of medullary carcinoma and other subtypes group do not differ substantially. Treatment is based on disease stage, and in early stages conservative breast surgy, followed by chemotherapy and radiotherapy strongly recommended [8].

Radiotherapy and chemotherapy were common adjuvant therapies for invasive breast cancers. however, it was often suggested that MBC had good prognosis and therefore may be not benefit from systemic. There was a study found chemotherapy would improve 5- and 10-year overall survival (OS). However, the P value was 0.08, which might not be solid [11].