PMC9516106_01
(A) Enlarging right breast cancer with a painless, ulcerated, hard, irregular mass in the union of the upper quadrants. (B) Voluminous hypermetabolic mass of 18.4x15.6cm, with a cystic component in the right breast and a SUVmax >4.
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Physical examination showed a gigantic right breast, more than four times larger than its counterpart associated with an ulcerated, hard, and erythematous nodule of 6 x 6 cm within the union of the upper quadrants ( Figure 1A ). PET-CT showed a voluminous hypermetabolic mass in the right breast, compatible with a primary tumor, with locoregional lymph node involvement and without any distant lesions ( Figure 1B ).
(A) Infiltrating carcinoma in diagnostic biopsy of the breast mass. (B) Representative images of the IF assay to detect biomarkers in the tumor. Geminin (GMN) and DAPI identify cells in S/G2 cell cycle phase. Left, RAD51 nuclear foci are only found in normal cells (closed triangle) but not in tumor cells (open triangles). Right, abundant dsDNA damage (gammaH2AX foci) and BRCA1 foci in tumor cells. Scale, 10 microm.
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Stromal tumor-infiltrating lymphocytes were low (5%) ( Figure 2A ). HRD ( Figure 2 ). High levels of yH2AX (50%57%) and BRCA1 (90%93%) were found, consistent with the same phenotype.
(A) Complete metabolic response due to persistence of a voluminous cystic left breast lesion with a thin wall of low uptake of FDG ((SUVmax:2,21) and complete disappearance of ipsilateral locoregional lymphadenopathy. (B) After completing NAC, the nodule at the union of the upper quadrants disappeared.
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Taking into account the complexity of the tuoral mass and the high risk of local and distant disease progression, NAC efficacy was assessed by performing a PET-CT after concluding NAC, showing a complete metabolic response but the persistence of the voluminous cystic right breast lesion with complete disappearance of the ipsilateral locoregional lymphadenopathies ( Figures 3A, B ).
(A) Cystic cavity with necrohemorrhagic content covered by a thick fibrous wall with abundant sero-hemorrhagic fluid. (B) Histopathological examination of mastectomy specimens. No tumoral cells were found.
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The patient underwent a modified radical mastectomy plus axillary lymphadenectomy ( Figure 4A ). These included a cystic cavity with necrohemorrhagic content lined by a dense fibrous wall with a moderate lymphohistiocytic component and hemosiderin deposits, secondary to old bleeding, without evidence of residual neoplastic cellularity ( Figure 4B ). ypT0N0 Residual Cancer Burden: 0.