Synchronous breast cancer

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 63 years old lady
  • Had underlying hypertension and CVA with left sided hemiparesis, ADL semi dependent walking with walking stick at home
  • Referred from GP
  • Patient noted right breast lump on SBE
  • Gradually increasing in size, non tender
  • No nipple discharge, no skin changes, no LOA, no LOW
  • No family history of breast cancer
  • Breastfed all 5 children up to 5 years
  • Clinically a palpable mass at right axillary tail measuring 3×3 cm, hard, attached to the skin not to the chest wall, peau de orange +ve. No nipple retraction, right axillary node palpable.
  • Left breast is normal, left axilla is also normal
Bilateral mammogram in MLO views
BIlateral mammogram in CC views

Mammogram findings:

  • There is an ill-defined oval high density lesion observed in the upper outer quadrant of the right breast (yellow arrows) with associated stromal distortion and skin traction.
  • No clustered microcalcification seen within the lesion.
  • A few lobulated lesions are seen at right axillary tail region.
  • An ill-defined lesion with associated stromal distortion is also seen in the upper outer quadrant of the left breast. No calcification is seen within this lesion.
  • ┬áSkin thickening is seen at right periareolar region.
  • No nipple retraction bilaterally.

Ultrasound shows suspicious lesions in both breasts (images not shown)

HPE finding:

  • Invasive carcinoma of right breast lesion
  • Invasive carcinoma of left breast lesion

Diagnosis: Bilateral synchronous breast cancer

Discussion:

  • Synchronous breast cancers are two or more primary breast cancers that occur in either breast at the same time
  • About 1.4-12% of all breast cancers may be synchronous
  • Bilaterality is greatest with invasive lobular carcinoma
  • It is important to consider metastasis to the breast from opposite breast (which is unusual especially with no other evidence of metastasis)
  • It has worse survival rates because of distant metastasis

Progress of patient:

  • CT scan for staging do not demonstrate distant metastasis
  • The right and left breast lesion with lymphadenopathies are again seen
  • Patient had chemotherapy at another hospital and lost to follow up
CT scan thorax, post contrast soft tissue window in axial plane showing right axillary nodes (white arrows), right breast mass (yellow arrows) and left breast lesion (red arrow)
Author: radhianahassan