Esclovon Jonathan Walter, Ponder Melissa, Aydin Nail, Misra Subhasis
Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA.
BMJ Case Rep. 2016 Aug 18;2016:bcr2016216201. doi: 10.1136/bcr-2016-216201.
A 59-year-old woman with right breast mass was diagnosed with invasive ductal carcinoma (IDC). Workup consisted of bilateral diagnostic mammogram and ultrasound (US); both showed a right breast mass with normal left breast. Core biopsy showed IDC with estrogen receptor negative (ER-)/progesterone receptor negative (PR-) and HER2/neu positive receptor status. The patient underwent carboplatin-based chemotherapy with Herceptin. The mass completely resolved. The patient desired to proceed with bilateral total mastectomy with right sentinel lymph node biopsy (SLNB). Pathology showed complete resolution of the right-sided breast mass without malignancy in right SLN. Incidentally, IDC was found in the left breast specimen, which was ER+/PR+ and HER 2/neu negative. Tumour board consensus was to obtain a left axilla US with MRI in 6 months if the US was unremarkable. Biologically different synchronous bilateral breast cancer poses a difficult clinical challenge for management due to differing responses to treatment. Use of MRI may be a diagnostic option in women who choose contralateral prophylactic mastectomy.
一名59岁的右乳肿块女性被诊断为浸润性导管癌（IDC）。检查包括双侧诊断性乳房X线摄影和超声检查（US）；两者均显示右乳有肿块，左乳正常。粗针活检显示IDC，雌激素受体阴性（ER-）/孕激素受体阴性（PR-），HER2/neu受体状态阳性。该患者接受了以卡铂为基础的化疗并使用赫赛汀。肿块完全消退。患者希望进行双侧全乳切除术并进行右前哨淋巴结活检（SLNB）。病理显示右侧乳房肿块完全消退，右前哨淋巴结无恶性肿瘤。偶然发现，左乳标本中存在IDC，其ER+/PR+且HER 2/neu阴性。肿瘤委员会的共识是，如果超声检查无异常，6个月后对左腋窝进行超声检查并联合MRI检查。由于对治疗的反应不同，生物学上不同的同步双侧乳腺癌对治疗构成了困难的临床挑战。对于选择对侧预防性乳房切除术的女性，使用MRI可能是一种诊断选择。
