Interhospital GRAND ROUND

Locally advanced breast cancer

Case presentation

1 June 2024
 A Thai male 71 years old
• U/D DM, HT, DLP
• Deny any family history of cancer

• Present with Left breast mass with ulcer 3 months PTA

• Breast : palpable subareolar mass 6 cm with ulcer involved nipple
with contact bleeding
• Axilla : palpable matted Lt. axillary LN size 2.5 cm
• No supraclavicular LN enlargement
IMAGING
Mammogram (6/9/66)
CC view
Mammogram (6/9/66)
MLO view
Breast ultrasound (6/9/66)
NEXT STEP?
 A Thai male 71 years old

• Core needle biopsy 20/9/2023:

• Lt. subareolar mass : invasive ductal carcinoma gr.3
• IHC: ER positive 95%, PR positive 95%, HER2 score 0, Ki67 30%

• FNA Lt.ALN (8/11/2023) : metastatic carcinoma

Impression: Lt. Breast cancer cT4bN2Mx
 o Echo cardiogram: EF 67%

Further o
o
Metastatic work up
CT chest + upper abdomen

investigation o Bone scan

CT chest + upper abdomen (16/10/2023)
 CT chest + upper abdomen (16/10/2023)

• A 5.8x5.0x7.2-cm lobulated heterogeneous enhancing mass at left

central breast abutting chest wall associated with skin thickening
• A few enlarged left axillary lymph node, size up to 1.6 cm in short axis
• A Tiny nodule at medial segment of RML, indeterminate nature
Bone scan (18/10/2023)
>> No evidence of bone metastasis
NEXT STEP?
 A Thai male 71 years old
• IMP : Lt. breast cancer cT4bN2M0 luminal B, HER2 negative

• Neoadjuvant chemotherapy >> 4AC + 4T

• Breast: Lt. subareolar mass 2.0 cm with heal ulcer
• Axilla: non palpable Lt. ALN

• Repeat CT chest + upper abdomen (14/04/2024)

CT chest + upper abdomen (14/04/67)
 CT chest + upper abdomen (14/04/67)

• Decrease size of an left breast involving left nipple, now measuring 2.0 cm.
• Decrease size of left axillary lymph nodes, now measuring up to 0.5 cm in
short axis
• No mediastinal/abdominal lymphadenopathy or liver metastasis.
• Diffuse mild bronchial wall thickening may represent bronchitis.
• No change of a 2.0 cm fluid attenuation lesion at 1st part duodenum, favor
benign lesion.
Genetic testing
Result - No genomic variants
Operation Left mastectomy with axillary
lymph node dissection
Histopathology report
Left breast

- Invasive ductal carcinoma, grade 3

- Tumor size 2.2 cm.

- No LVI

- DCIS present

- free all margin

- ALN 4/13 with ENE

- IHC: ER positive 95%, PR positive 80%, HER2 score 0, Ki67 30%

 A Thai male 71 years old : plan for treatment
• Imp: Left CA breast ypT2N2M0

Chemotherapy -
Radiation RT due to LN and T stage
Hormonal therapy AI
Targeted therapy CDK 4/6i : abemaciclib
Thank you • Q&A