Pregnancy-Associated Breast Cancer
A 23-year-old Caucasian woman first presented to our department 15 years ago with a palpable mass in her left breast three months after the delivery of her third child. At the time, she was breast-feeding. She had no family history of breast or ovarian cancer, and no personal history of breast disease. Menarche occurred at age thirteen, and she was nineteen when she delivered her first child. In view of her young age and Ashkenazi Jewish heritage, she subsequently underwent genetic testing, which was negative for BRCA1 and BRCA2 mutations. At the time of her initial presentation, an ultrasound of her left breast revealed a 1.7 cm mass in the area of palpable abnormality, and ultrasound guided fine needle aspiration (FNA) was suspicious for carcinoma. Extensive microcalcifications in her left breast were demonstrated on mammography. A left breast lumpectomy showed extensive intraductal and invasive ductal carcinoma with multifocally involved margins. The largest single focus of invasive cancer measured 1.5 cm. The cancer was 38 % estrogen receptor positive and 35 % progesterone receptor positive. Our patient then underwent a left total mastectomy with axillary lymph node dissection and transverse rectus abdominis myocutaneous flap reconstruction. The pathology at the time revealed additional extensive intraductal carcinoma, and axillary nodes showed no evidence of disease. Postoperatively, she received chemotherapy with cyclophosphamide, doxorubicin (Adriamycin) and 5-fluorouracil and was maintained on tamoxifen and leuprolide for three years. She was monitored closely and was without evidence of recurrence for approximately 10 years.
Five years ago, our patient was evaluated with mammography, ultrasound and magnetic resonance imaging, which showed no evidence of malignancy in the contralateral breast. Our patient returned six months later, 20 weeks pregnant, at which time her clinical exam was unremarkable. One month later, our patient presented in the 24th week of pregnancy with a palpable mass in the upper-outer portion of her reconstructed left breast. On examination, a subcutaneous mass was appreciated, associated with the native skin of her reconstructed left breast. FNA of the mass identified malignant cells. Our patient underwent wide local excision of the mass. Histology confirmed poorly differentiated breast carcinoma invading into adipose tissue. The tumor, measuring 0.4 cm in its widest dimension, was noted to be estrogen receptor negative, but highly progesterone receptor positive (95 %) with overexpression of human epidermal growth factor receptor 2/Neu. After delivery of a healthy male child at term, our patient was treated with tamoxifen and trastuzumab and underwent radiation therapy to her left chest wall. At present, she remains on tamoxifen and is doing well without recurrent disease.
Case Presentation
A 23-year-old Caucasian woman first presented to our department 15 years ago with a palpable mass in her left breast three months after the delivery of her third child. At the time, she was breast-feeding. She had no family history of breast or ovarian cancer, and no personal history of breast disease. Menarche occurred at age thirteen, and she was nineteen when she delivered her first child. In view of her young age and Ashkenazi Jewish heritage, she subsequently underwent genetic testing, which was negative for BRCA1 and BRCA2 mutations. At the time of her initial presentation, an ultrasound of her left breast revealed a 1.7 cm mass in the area of palpable abnormality, and ultrasound guided fine needle aspiration (FNA) was suspicious for carcinoma. Extensive microcalcifications in her left breast were demonstrated on mammography. A left breast lumpectomy showed extensive intraductal and invasive ductal carcinoma with multifocally involved margins. The largest single focus of invasive cancer measured 1.5 cm. The cancer was 38 % estrogen receptor positive and 35 % progesterone receptor positive. Our patient then underwent a left total mastectomy with axillary lymph node dissection and transverse rectus abdominis myocutaneous flap reconstruction. The pathology at the time revealed additional extensive intraductal carcinoma, and axillary nodes showed no evidence of disease. Postoperatively, she received chemotherapy with cyclophosphamide, doxorubicin (Adriamycin) and 5-fluorouracil and was maintained on tamoxifen and leuprolide for three years. She was monitored closely and was without evidence of recurrence for approximately 10 years.
Five years ago, our patient was evaluated with mammography, ultrasound and magnetic resonance imaging, which showed no evidence of malignancy in the contralateral breast. Our patient returned six months later, 20 weeks pregnant, at which time her clinical exam was unremarkable. One month later, our patient presented in the 24th week of pregnancy with a palpable mass in the upper-outer portion of her reconstructed left breast. On examination, a subcutaneous mass was appreciated, associated with the native skin of her reconstructed left breast. FNA of the mass identified malignant cells. Our patient underwent wide local excision of the mass. Histology confirmed poorly differentiated breast carcinoma invading into adipose tissue. The tumor, measuring 0.4 cm in its widest dimension, was noted to be estrogen receptor negative, but highly progesterone receptor positive (95 %) with overexpression of human epidermal growth factor receptor 2/Neu. After delivery of a healthy male child at term, our patient was treated with tamoxifen and trastuzumab and underwent radiation therapy to her left chest wall. At present, she remains on tamoxifen and is doing well without recurrent disease.
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