Teaching Case Answer

Don’t let breast cancer steal the second base

May 2023
​Contributed By:

Dr.Suma Chakrabarthi
Peerless Hospital, Kolkata,

Clinical History:

44 yrs old Female Palpable lump in left breast for few weeks No right breast symptom

Quiz Question

What is the diagnosis? What will you do next?

Answer

Findings
Mammography Right: upper central high density irregular shaped mass with spiculated margin. Nipple retracted. Left: upper central high density mass with spiculated margin. Nipple retracted. Ultrasound: findings described with images

Answer
Impression: Bilateral BIRADS-5 mass. Bilateral primary breast carcinoma Next steps: - Bilateral breast mass core biopsy (confirmed IDC) - Referral to ‘high risk breast clinic’ as bilateral breast cancer

Discussion
Bilateral breast cancer: Bilateral synchronous breast cancer accounts for 0.2–2% of all breast cancers   the risk of having breast cancer is substantially increased with a first–degree relative with bilateral breast cancer worse overall survival compared to unilateral tumours lower disease free survival and high rates of distant metastasis Synchronous breast cancer has a poorer prognosis than metachronous or unilateral breast cancer  Please remember: Always perform ‘Bilateral mammography’ as the asymptomatic breast may have an impalpable abnormality. We are essentially screening the asymptomatic breast. Assess each breast lesion robustly when there are multiple abnormalities. THANK YOU FOR YOUR TIME!

Reference
Dalal AK, Gupta A, Singal R, Dalal U, Attri AK, Jain P, Sharma A, Gupta S. Bilateral breast carcinoma- a rare case report. J Med Life. 2011 Jan-Mar;4(1):94-6. Epub 2011 Feb 25. PMID: 21505580; PMCID: PMC3056428.

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