Presentation
An elderly female with a right breast mass. No discharge per nipple. No obvious skin changes.
Patient Data
An irregular elongated wider-than-taller hypoechoic lobulated mass lesion measuring 2.0 x 1.1 cm is seen in the upper outer quadrant of the right breast at 9-10 O' clock location.
An enlarged node measuring 1.3 x 0.7 cm is seen in the right axilla with thickened cortex and disrupted hilum. No peri-nodal fat stranding is seen.
US-guided biopsy was performed from the right breast mass and FNAC from the suspicious right axillary lymph node.
Case Discussion
An elderly woman presented to our clinic with a lump in the right breast. The swelling was firm, immobile, and slightly tender on clinical examination.
A lobulated hypoechoic mass lesion in the right breast's upper outer quadrant was confirmed on US examination. An enlarged suspicious right axillary node was also noted.
US-guided biopsy from the breast mass and FNAC from the right axillary node yielded the following results.
Histopathology report:
Estrogen receptor (ER) / Progesterone receptor (PR) / HER2 (ERBB2): Negative.
Ki-67: 60 % (Normal range <30 %).
Nodal status: Negative.
Conclusion: Invasive ductal triple-negative breast carcinoma (TNBC) with a high Ki-67 index.
Short discussion:
Triple-negative breast cancer (TNBC) is a type of breast cancer that presents no/low levels of estrogen (ER)/progesterone (PR)/human epidermal growth factor 2 (HER2) receptors.
TNBC affects young women or women with BRCA1 gene mutation, comprising nearly 20% of all breast cancers. TNBC consists of a vivid group of breast cancers and is the most difficult type to manage. Initial treatment usually consists of surgery, radiation, and chemotherapy while later stages require chemotherapy and targeted therapy.
The relapse rate is quite high in the initial 5 years but is lower than hormone-positive variants in the later stages.
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