PMC6926980_01
Left breast, 12 o'clock position, 3 cm from nipple, ultrasound-guided core needle biopsy (July 30, 2014): (A) Poorly differentiated infiltrating ductal cell carcinoma, Nottingham Histologic Grade 3. (B) High nuclear grade ductal carcinoma in situ (DCIS) with necrosis, displaying comedo and micropapillary patterns. Left breast, modified radical mastectomy, S/P neoadjuvant chemotherapy (March 25, 2015): (C) Residual invasive ductal carcinoma with treatment effect. No residual DCIS identified.
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TCHP (docetaxel, cyclophosphamide, trastuzumab, and pertuzumab) with good clinical response, and she underwent a modified radical mastectomy with level II axillary lymph node dissection, showing partial pathological response ypT2N0M0 (Figure 1). This was followed by adjuvant radiation, and 1 year of adjuvant herceptin.
Right breast, 12:00, 4 cm from nipple; ultrasound-guided core biopsy (September 12, 2010): (A) Infiltrating ductal carcinoma, micropapillary type, Nottingham Histologic Grade 2. Right breast, total skin and nipple-sparing mastectomy (April 13, 2017): (B) No residual invasive carcinoma present; mammary tissue with treatment-related charges. (C) Abundant lymphatic involvement present.
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Biopsy confirmed invasive ductal carcinoma grade 2, ER+/PR+/HER2+ breast cancer (Figure 2). She underwent mastectomy, showing a complete pathological response in the primary tumor, but with residual isolated tumor cells in 1 out of 4 axillary nodes and lymphovascular invasion, ypTx N0(itc)(sn; Figure 2). While on adjuvant trastuzumab, petuzumab, and luprolide, she developed multiple brain parenchymal and leptomeningeal metastases within 15 months of initial tumor diagnosis (Figure 2).