Wang Yuanliang, Wang Yu, Sun Suhong
Department of General Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China.
AME Case Rep. 2025 Apr 3;9:69. doi: 10.21037/acr-24-223. eCollection 2025.
Pregnancy-associated breast cancer (PABC) occurs during the special physiological period of female pregnancy, requiring a clinical approach that considers both the effectiveness of maternal treatment and the safety of the baby, creating a clinical challenge. This article discusses the diagnosis and treatment of two PABC cases and provides a thorough review of existing literature to offer insights for clinical practice.
Patient A, a 41-year-old female at 30 weeks and 2 days of gestation, was diagnosed with left breast invasive carcinoma. Following one cycle of AC regimen chemotherapy, she successfully delivered a female infant at 35 weeks and 5 days of gestation. Subsequently, she received 5 cycles of THP regimen neoadjuvant therapy after childbirth. Then, she underwent left breast-conserving surgery and left axillary lymph node dissection. Postoperative pathology indicated pathologic complete response. Post-surgery, she received radiotherapy and targeted therapy. Patient B, a 33-year-old female at 27 weeks and 1 day of gestation, was diagnosed with left breast ductal carcinoma in situ (DCIS). She underwent left total mastectomy with left sentinel lymph node biopsy. Pathology post-surgery revealed intermediate-grade DCIS of the left breast concomitant with locally non-special type invasive carcinoma. No tumour metastasis was identified in the left sentinel lymph node. At 36 weeks of pregnancy, she delivered a male infant and subsequently received 4 cycles of AC regimen chemotherapy. After completing the chemotherapy, a newly formed mass was discovered in her right breast. Right breast mass mastectomy with vacuum assisted biopsy system was performed. Intraoperative pathology indicated intermediate-grade intraductal papillary carcinoma. During surgery, she underwent right total mastectomy and sentinel lymph node biopsy. Intraoperative frozen section analysis revealed the absence of tumour spread in the sentinel lymph nodes (0/8). Postoperatively, she received systematic endocrine therapy.
Both patients had successful outcomes for the unborn babies following delivery. By prioritizing the safety of both the mother and the child, tailored breast cancer treatments were given to the two individuals, leading to effective therapy. Clinicians should increase their awareness and knowledge of PABC to avoid misdiagnosis or overlooking diagnoses.
妊娠相关乳腺癌（PABC）发生于女性妊娠这一特殊生理时期，需要一种兼顾母体治疗效果和胎儿安全的临床处理方法，这给临床带来了挑战。本文讨论了两例PABC病例的诊断与治疗，并对现有文献进行全面综述，为临床实践提供见解。
患者A，一名妊娠30周零2天的41岁女性，被诊断为左乳浸润性癌。在接受一个周期的AC方案化疗后，她于妊娠35周零5天成功分娩一名女婴。随后，她在产后接受了5个周期的THP方案新辅助治疗。然后，她接受了左乳保乳手术和左腋窝淋巴结清扫术。术后病理显示病理完全缓解。术后，她接受了放疗和靶向治疗。患者B，一名妊娠27周零1天的33岁女性，被诊断为左乳导管原位癌（DCIS）。她接受了左乳全切除术及左前哨淋巴结活检。术后病理显示左乳中级别DCIS合并局部非特殊类型浸润性癌。左前哨淋巴结未发现肿瘤转移。妊娠36周时，她分娩了一名男婴，随后接受了4个周期的AC方案化疗。化疗完成后，她右乳发现一个新形成的肿块。进行了右乳肿块切除术及真空辅助活检系统检查。术中病理显示为中级别导管内乳头状癌。手术中，她接受了右乳全切除术及前哨淋巴结活检。术中冰冻切片分析显示前哨淋巴结无肿瘤转移（0/8）。术后，她接受了系统性内分泌治疗。
两名患者分娩后未出生的婴儿均获得成功结局。通过优先考虑母婴双方的安全，为这两名患者提供了量身定制的乳腺癌治疗方案，从而实现了有效的治疗。临床医生应提高对PABC的认识和了解，以避免误诊或漏诊。
