Abscess-like postpartum metaplastic breast carcinoma in breastfeeding woman: a case report

ABSTRACT

Introduction: Breast cancer diagnosed within 10 years of parturition is named postpartum breast cancer which is a highly metastatic tumor with poor prognosis.

Case Report: A 31-year-old female presented with fever and painful mass in the left breast. She had undergone C-section 6 months ago of her second child. A left breast biopsy was performed and showed estrogen receptor-negative, progesterone receptor-negative, and human epidermal growth factor receptor 2 (HER2) negative invasive highly differentiated carcinoma. A radical mastectomy and left axillary lymphadenectomy were then performed and the anatomopathological report showed a 16cm metaplastic breast carcinoma. Eight months after the start of the chemotherapy treatment, the patient was diagnosed with brain metastases.

Discussion: Postpartum breast cancer is associated with worse survival rates presenting increased risk of death. Metaplastic breast carcinoma is a subtype of triple-negative breast cancer also associated with poor prognosis and chemotherapy treatment resistant, being surgery the standard treatment.

RESUMO

Introdução: O câncer de mama diagnosticado até 10 anos depois do parto é chamado câncer de mama pós-parto, um tipo altamente metastático e com mau prognóstico.

Relato de Caso: Mulher, 31 anos, se apresentou com febre e uma massa hiperêmica e dolorosa na mama esquerda. Ela havia passado por uma cesárea seis meses antes de seu segundo filho. Foi realizada uma biópsia na mama esquerda e a análise histológica e imunoistoquímica mostrou um carcinoma altamente diferenciado negativo para receptor de estrógeno, de progesterona e do fator de crescimento epidermal humano 2 (HER2). Mastectomia radical e linfadenectomia axilar esquerda foram realizadas e a análise anatomopatológica indicou um carcinoma metaplásico de mama de 16 cm. Oito meses depois do início da quimioterapia, a paciente foi diagnosticada com metástase cerebral.

Discussão: O câncer de mama pós-parto é associado a taxas ruins de sobrevida apresentando de duas a três vezes mais risco de morte. O câncer de mama metaplásico é também associado a um prognóstico ruim e a resistência ao tratamento quimioterápico, sendo a cirurgia o tratamento padrão.

Keywords:

Lymphatic metastasis - Triple negative breast neoplasms - Inflammatory breast neoplasms

Descritores:

Metástase linfática - Neoplasias mamárias triplo negativas - Neoplasias inflamatórias da mama

Publication History

Received: 27 October 2022

Accepted: 13 January 2023

Article published online:
02 February 2023

• REFERENCES

• 1 Goddard ET, Bassale S, Schedin T, Jindal S, Johnston J, Cabral E. et al. Association between postpartum breast cancer diagnosis and metastasis and the clinical feature underlying risk. JAMA Netw Open 2019; Jan 2 (01) e186997
• 2 Schedin P. Pregnancy-associated breast cancer and metastasis. Nat Rev Cancer 2006; Apr 6 (04) 281-291
• 3 Martinson HA, Jindal S, Durand-Rougely C, Borges VF, Schedin P. Wound-healing like immune program facilitates postpartum mammry gland involution and tumor progression. Int J Cancer 2015; Apr 136 (08) 1803-13
• 4 Lyons TR, O’Brien J, Borges VF, Conklin MW, Keely PJ, Eliceiri KW. et al. Postpartum mammary gland involution drives progression of ductal carcinoma in situ through collagen and COX-2. Nat Med 2011; Aug 17 (09) 1109-15
• 5 World Health Organization (WHO). Breast cancer. Geneva: WHO; 2018
• 6 Callihan EB, Gao D, Jindal S, Lyons TR, Manthey E, Edgerton S. et al. Postpartum diagnosis demonstrates a high risk for metastasis and merits an expanded definition of pregnancy-associated breast cancer. Breast Cancer Res Treat 2013; Apr 138 (02) 549-59
• 7 Lefrère H, Lenaerts L, Borges VF, Schedin P, Neven P, Amant F. Postpartum breast cancer: mechanisms underlying its worse prognosis, treatment implications, and fertility preservation. Int J Gynecol Cancer 2021; Mar 31 (03) 412-22
• 8 Qiu R, Zhong Y, Hu M, Wu B. Breastfeeding and reduced risk of breast cancer: a systematic review and meta-analysis. Comput Math Methods Med 2022; Jan 2022: 1-9
• 9 Goddard ET, Bassale S, Schedin T, Jindal S, Johnston J, Cabral E. et al. Association between postpartum breast cancer diagnosis and metastasis and the clinical features underlying risks. JAMA Netw Open 2019; Jan 2 (10) e186997
• 10 Jindal S, Pennock ND, Sun D, Horton W, Ozaki MK, Narasimhan J. et al. Postpartum breast cancer has a distinct molecular profile that predicts poor outcomes. Nat Commun 2021; Nov 12 (01) 6341-55
• 11 Amant F, Mickwitz G, Han SN, Bontenval M, Ring AE, Giermek J. et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol 2013; Jul 31 (20) 2532-9
• 12 Stensheim H, Møller B, Van Dijk T, Fossa SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 2009; Jan 27 (01) 45-51
• 13 Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011; Mar 144 (05) 646-74
• 14 Oberman HA. Metaplastic carcinoma of the breast. A clinicopathologic study of 29 patients. Am J Surg Pathol 1987; Dec 11 (12) 918-29
• 15 Rakha EA, Tan PH, Varga Z, Tse GM, Shaaban AM, Climent F. et al. Prognostic factors in metaplastic carcinoma of the breast: a multi-institutional study. Br J Cancer 2015; Jan 112 (02) 283-9
• 16 Leyrer CM, Berriochoa CA, Agrawal S, Donaldson A, Calhoun BC, Shah C. et al. Predictive factors on outcomes in metaplastic breast cancer. Breast Cancer Res Treat 2017; Oct 165 (03) 499-504
• 17 González-Martínez S, Pérez-Mies B, Pizarro D, Caniego-Casas T, Cortés J. Palacios.
• 18 Gooding AJ, Schiemann WP. Epithelial-mesenchymal transition programs and cancer stem cell phenotypes: mediators of breast cancer therapy resistance. Mol Cancer Res 2020; Sep 18 (09) 1257-1270