Xue Lixin, Sheng Zhengzuo
Department of General Surgery, Fu Xing Hospital, the Eighth Clinical Medical College Capital Medical University Beijing China.
Department of Thoracic Surgery, Fu Xing Hospital, the Eighth Clinical Medical College Capital Medical University Beijing China.
Clin Case Rep. 2025 Sep 4;13(9):e70850. doi: 10.1002/ccr3.70850. eCollection 2025 Sep.
Lactation-associated breast cancer poses diagnostic challenges due to physiological breast changes that may mask malignancies. Triple-negative breast cancer (TNBC) during lactation is rare and aggressive, requiring vigilant evaluation and treatment. This report highlights the diagnostic dilemma of recurrent cystic breast lesions during lactation, which can mimic benign conditions like galactoceles but may conceal aggressive TNBC, leading to potential delays in diagnosis despite initial conservative approaches such as aspiration. A 26-year-old lactating woman presented with recurrent complex cystic lesions initially mistaken for benign lactational changes. Despite multiple aspirations, the lesions enlarged, leading to surgical excision. Pathology confirmed TNBC (ER-, PR-, HER2-, Ki-67 ~40%). Core needle biopsy and extended resection with sentinel lymph node biopsy confirmed grade III invasive ductal carcinoma. The patient received 8 cycles of chemotherapy (4 cycles of pegylated liposomal doxorubicin and cyclophosphamide, followed by 4 cycles of taxane) without radiotherapy, achieving 6-year recurrence-free survival. Persistent complex cystic lesions during lactation require core needle biopsy to rule out malignancy. Multimodal TNBC treatment can yield favorable outcomes, including fertility preservation, as evidenced by the patient's subsequent pregnancy in 2024.
哺乳期相关乳腺癌因可能掩盖恶性肿瘤的生理性乳房变化而带来诊断挑战。哺乳期三阴性乳腺癌（TNBC）罕见且侵袭性强，需要进行警惕的评估和治疗。本报告强调了哺乳期复发性乳腺囊性病变的诊断困境，这些病变可能类似积乳囊肿等良性情况，但可能掩盖侵袭性TNBC，尽管最初采取了如穿刺抽吸等保守方法，仍可能导致诊断潜在延迟。一名26岁哺乳期妇女出现复发性复杂囊性病变，最初被误诊为良性哺乳期变化。尽管多次穿刺抽吸，病变仍增大，最终进行了手术切除。病理证实为TNBC（雌激素受体阴性、孕激素受体阴性、人表皮生长因子受体2阴性、Ki-67约40%）。粗针活检及前哨淋巴结活检的扩大切除术证实为III级浸润性导管癌。该患者接受了8个周期的化疗（4个周期的聚乙二醇化脂质体阿霉素和环磷酰胺，随后4个周期的紫杉烷），未接受放疗，实现了6年无复发生存。哺乳期持续存在的复杂囊性病变需要进行粗针活检以排除恶性肿瘤。多模式TNBC治疗可产生良好结果，包括保留生育能力，该患者在2024年随后怀孕就证明了这一点。
