Tang Tiantian, Liu Yueping, Yang Chao, Ma Li
Breast Center, the Fourth Hospital of Hebei Medical University.
Department of Pathology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Medicine (Baltimore). 2020 Oct 30;99(44):e22929. doi: 10.1097/MD.0000000000022929.
The incidence of pregnancy-associated breast cancer (PABC) is increasing nowadays, and its diagnosis and treatment remain complicated due to the consideration of the fetus. The available data on PABC are primarily derived from case reports since there are ethical restrictions on conducting randomized clinical trials. In the present work, we reported a case of the human epidermal growth factor receptor 2 (HER2)-positive PABC and described the diagnosis and treatment for such type of breast cancer.
A 27-year-old patient was admitted to our hospital with the complaints of right breast mass for 3 days, and she was a first-time pregnant woman with a single live intrauterine fetus at 26 + 3 weeks of gestation. Physical examination of the right breast revealed a palpable and hard mass with obscure boundaries (5.0 cm × 4.0 cm) in the upper outer quadrant. Significant axillary lymph nodes (2.0 cm) were also present.
PABC.
To protect the fetus, breast ultrasonography was used to test her breast mass, a core needle biopsy was adopted to confirm the diagnosis, and abdominal ultrasound and chest X-ray were used to evaluate the metastasis. The patient was scheduled for neoadjuvant therapy using bi-weekly pirarubicin in combination with cyclophosphamide (AC) without anti-HER2 therapy for consideration of the fetus's safety. After 4 cycles of AC, the patient delivered a healthy male infant. After the delivery, all the treatments were carried out according to the standard recommendation for HER2 + breast cancer as non-pregnant patients.
After the surgery, the disease-free survival for the patient was 12 months until brain metastasis was diagnosed. She was still undergoing second-line anti-HER2 therapy and currently in a stable situation. Besides, the child was also healthy so far.
The methods for the diagnosis and treatment of PABC that result in teratogenesis should be avoided to protect the fetus. Mammogram and chest X-ray were safe approaches for the fetus. Moreover, chemotherapy-based on pirarubicin in combination with cyclophosphamide had no risk to the fetus.
如今，妊娠相关乳腺癌（PABC）的发病率正在上升，由于要考虑胎儿因素，其诊断和治疗仍然很复杂。由于进行随机临床试验存在伦理限制，关于PABC的现有数据主要来自病例报告。在本研究中，我们报告了一例人表皮生长因子受体2（HER2）阳性的PABC病例，并描述了此类乳腺癌的诊断和治疗方法。
一名27岁患者因右乳肿块3天入院，她是一名初产妇，妊娠26 + 3周，单活胎。右乳体格检查发现上外象限可触及一个边界不清的硬块（5.0厘米×4.0厘米）。腋窝也有明显肿大的淋巴结（2.0厘米）。
PABC。
为保护胎儿，使用乳腺超声检查其乳房肿块，采用粗针活检确诊，并使用腹部超声和胸部X线评估转移情况。考虑到胎儿安全，患者计划接受每两周一次的吡柔比星联合环磷酰胺（AC）新辅助治疗，不进行抗HER2治疗。4个周期的AC治疗后，患者产下一名健康男婴。分娩后，所有治疗均按照HER2 +乳腺癌非妊娠患者的标准建议进行。
手术后，患者无病生存期为12个月，直至被诊断出脑转移。她仍在接受二线抗HER2治疗，目前情况稳定。此外，孩子目前也很健康。
应避免采用可能导致致畸的PABC诊断和治疗方法以保护胎儿。乳房X线摄影和胸部X线对胎儿是安全的方法。此外，基于吡柔比星联合环磷酰胺的化疗对胎儿没有风险。
