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Submitted Case

2022
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Patient Information: (Do not provide name of the patient)
Age
  60
Diagnosis
  bilateral breast cancer, status post neoadjuvant chemotherapy, bilateral mastectomies
Imaging
  Initial mammography and ultrasound demonstrated a 2.3 cm mass in the upper outer quadrant of the right breast, with no right axillary lymphadenopathy. In the left breast, 3 solid masses were present, measuring up to 1.3 cm, with an enlarged left axillary lymph node. MRI at diagnosis also demonstrated the right breast lesion, which measured 2.5 cm, with no right axillary lymphadenopathy. Multiple masses were also seen in the left breast, as well as a 10 cm area of calcifications, suspicious for DCIS and a 1.8 cm left axillary lymph node. No internal mammary lymphadenopathy was seen. A post-chemotherapy MRI showed the right breast mass to have decreased in size slightly (2.0 cm versus 2.1 cm. One of the left breast masses measured 1.0 cm, compared with a pre-chemotherapy measurement of 2.2 cm. Another mass had decreased from 1.0 cm to 0.6 cm, and a third mass had decreased from 0.9 cm to 0.6 cm. The left axillary lymph node had decreased from 2.5 cm to 1.6 cm.
Pathology
  Biopsy of the right breast mass showed invasive ductal carcinoma, grade 3, estrogen-receptor negative, progesterone-receptor negative, and HER2 negative, with a Ki-67 of 80%. Biopsies from the left breast showed invasive ductal carcinoma, grade 1-2, with intermediate-grade DCIS. A core needle biopsy from the suspicious left axillary lymph node showed metastatic breast carcinoma. Following chemotherapy, the right mastectomy specimen contained invasive ductal carcinoma, grade 3, with residual tumor measuring 1.6 cm and showing changes compatible with a partial response to neoadjuvant therapy. Two right axillary sentinel nodes were retrieved and were both negative. The mastectomy margins were free of tumor. Lymphovascular invasion was not identified. The left mastectomy specimen showed multicentric invasive ductal carcinoma, grade 1-2, the largest nodule measuring 1.2 cm. There was no morphologic evidence of response to therapy in the left breast tumor foci. The mastectomy margins were all free of tumor. Lymphovascular invasion was present. Metastatic carcinoma was found in 2 of 14 left axillary lymph nodes, the largest metastasis measuring 0.9 cm. Extranodal extension was not identified. The left breast tumors showed a Ki-67 of 15 to 20%.
Stage
  Right breast: Clinical stage IIA (T2 N0 M0), pathologic stage IA (ypT1c ypN0 M0).
Images
Session Name
  Breast Specialist Dr. Abram Recht- May 20, 2022
Session ID
  11809
created_by
  7517
post_id
  11809
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