YO2 - A Rare Case of Breast Cancer in A Postpartum Female with Reoccurrence of Breast Cancer During Pregnancy

Case summary

A 22 year old female who delivered a healthy baby girl 1 month ago came to the hospital with history of breast tenderness, nipple discharge & dimpling of the skin since 15 days .On physical exam, it was hard in consistency , retracted nipple associated with palpable subareolar mass & adhered to skin . Palpable lymph nodes (LN) in axilla. Mammogram revealed large spiculated mass , microcalcifications in subareolar region .Breast US showed hypoechogenic mass of irregular shape including subareolar area with poorly defined margins measuring 6cm x 5 cm x 4.3 cm in left breast and revealed 8 LN in left axilla. FNAC suspicious for CA & Incisional biopsy confirmed ER + ,PR+ , HER2+. No metastasis on PET scan. Histopathology revealed poorly differentiated malignant epithelial cells with high degree of nuclear pleomorphism , ER+,PR+ and HER2 positive confirms invasive infiltrating ductal CA, staging T4N2M0.The patient was started on neoadjuvant chemotherapy(CTX) with cisplatin , adriamycin & paclitaxel followed by modified radical mastectomy(MRM) of left breast & lumpectomy along with axillary LN dissection. The patient was then given tamoxifen 20mg/day . Post therapy follow up was done after every 3 months yearly.

After 3 years, she notices progressive growth on her right breast which was hard in consistency, round shaped mass on the outer quadrant , adhered to the chest wall with tender palpable & movable axillary LN. Mammography revealed large poorly defined, noncalcified mass on right breast. Breast US showed 5.5cm poorly defined mass with 2x2 cm anterior axillary LN .Histopathology revealed poorly differentiated, malignant epithelial cells in the ducts with high mitotic figures . It is ER+, PR+ and HER2 + & confirms invasive infiltrating ductal CA , staging T4N1M0 .

After a week we came to know that she’s pregnant for 4 months & doesn’t want to get an abortion. MRM of the right breast was done along with axillary LN dissection in her 5^th month & C- section was done in the 8^th month & a healthy baby was born. Post delivery CTX was started with 6 cycles of adriamycin & cyclophosphamide followed by radiotherapy & hormonal therapy with tamoxifen.A follow up Pet scan showed no signs of recurrence or metastasis for 36 months after the treatment & surgery.

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