A 53 Year Old Woman with Ductal Carcinoma of Right Breast with Axillary Node Metastasis

This is a 53-year-old hypertensive/hypothyroidism woman who recently underwent FNAC of the axillary lymph nodes (2 months back) after a follow-up USG showed enlarged lymph nodes and multiple cysts in the right breast. She had been noticing an inverted right breast nipple from the last 4-5 months associated with skin thickening.

She had this cyst initially in both right and left breast, detected 5 years (2014) back, in a tertiary care hospital, during routine master health check-up and was reassured as it was thought to be a benign fibrocystic breast disease. However, 2 years later, she started to get on/off galactorrhea associated with intermittent right breast pain for the last 4 years. She was treated with cabergoline for her galactorrhea which used to subside the galactorrhea. She has a history of hysterectomy 3 years back. She does not have parental history of breast or any other cancer. Her grandmother died of non-breast cancer.

She was being routinely assessed for the cyst from time to time and was reassured about it. But she was worried this time due to the recent clinical breast features and opted to go for the FNAC which raised the suspicion of ductal carcinoma of the right breast with axillary node metastasis. This is was followed by trucut biopsy, repeat FNAC, PET-CT scan and other investigations which are shown below.

Patient evaluation summary

The first FNAC report:

Repeat USG

Repeat FNAC

Trucut biopsy

PET CT Scan

Coagulation profile:

Offline consultation with Breast Surgeon and Medical Oncologist

Breast Panel IHC 4:

Neoadjuvent Chemotherapy Plan

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