Patient description
25 yow, premenopausal, single, architecture student, without comorbidities.
Family history includes a paternal grandmother and 2 paternal aunts with breast cancer at a young age.
A gBRCA2 pathogenic mutation was documented.
Case history
She noticed a right breast lump over the last few weeks.
Physical examination results
Multifocal right breast nodules measuring 5.5, 3 and 2 cm.
Homolateral axillary N1 lymph nodes.
Results of pathological tests and other investigations
Core biopsy of 2 nodules showed infiltrating carcinoma of no special type, grade 3, lymphovascular invasion, ER 90%, PR 60%, HER2 0, ki67 40%.
PET-CT chowed no evidence of distant disease.
cT3N1Mo
Treatment plan
After oocyte cryopreservation, she received neoadjuvant chemotherapy with dose dense doxorubicin and cyclophosphamide followed by paclitaxel; preceded and concomitantly with an LHRH analogue.
Expected outcome of the treatment plan
Tumor downstaging with an attempt to perform a sentinel lymph node biopsy at the time of surgery.
Actual outcome
The tumor had a partial response to dose dense ACT and she underwent a bilateral mastectomy with immediate reconstruction and axillary dissection.
Pathology report showed a right side 4 mm residual tumor with 6 positive lymph nodes.
ypT1aypN2a (RCB III).
HR+, HER2 0, ki67 75%.
No disease in the left breast.
