IS Case 420: Synchronous bilateral breast cancer in a pregnant patient

Sara Ann Majewski, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-27

History

A 35-week-pregnant, 33-year-old female with a lump in the RIGHT breast noticed about 5 weeks before initial study. Per the patient, she also has a lump in the LEFT breast, previously worked up, which has become more prominent and hard.

Findings

Large, vascular, lobulated, complex masses in the bilateral breasts

Diagnosis

Synchronous bilateral breast cancer in a pregnant patient

Discussion

Most breast lesions in pregnancy and lactation are benign. Up to 3% of breast cancer occurs during pregnancy [6]. Making this diagnosis is difficult secondary to the hormone-related transformation in the breast during pregnancy. These cancers are larger and more advanced at the time of diagnosis and have a worse prognosis than in nonpregnant patients of the same age. More than half of patients have high grade tumors [3,4]. Poor prognosis may be secondary to delayed diagnosis or aggressive growth secondary to biologic consequences of pregnancy. There is a high incidence of inflammatory carcinoma in pregnant patients. More than half of these women have lymph node involvement. There is increased prevalence of hormone-receptor–negative and HER2/neu–positive cancers [3,4]. Recurrences are common typically within 3 years of diagnosis [3,4].

The usual presentation of breast cancer in pregnancy is a palpable mass. Less frequent findings include edema, erythema, and diffuse breast enlargement which may suggest locally advanced carcinoma [3,4]. Ultrasound (US) is the best modality for breast evaluation in pregnancy [1,2,7]. Mammograms are less sensitive during pregnancy and lactation secondary to increased glandular density, but does provide useful information. Mammography should be obtained when cancer is suspected. It shows many findings which may not be seen on US including microcalcifications, multifocality, multicentricity, or bilaterality [1,2,7]. This patient was diagnosed with synchronous ductal carcinoma of the bilateral breasts.

References

  1. Ahn BY, Kim HH, Moon WK, et al. Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med. 2003 May;22(5):491-7; quiz 498-9. PMID: 12751860
  2. Liberman L, Giess CS, Dershaw DD, Deutch BM, Petrek JA. Imaging of pregnancy-associated breast cancer. Radiology. 1994 Apr;191(1):245-8. PMID: 8134581
  3. Petrek J, R Theriault. Pregnancy-associated breast cancer and subsequent pregnancy in breast cancer survivors. In: Harris J, Lippman M, Morrow M, et al., eds. Disease of the Breast. 3rd ed. Lippincott Williams & Williams, Philadelphia: 2004; 1035-1046.
  4. Ring AE, Smith IE, Ellis PA. Breast cancer and pregnancy. Ann Oncol. 2005 Dec;16(12):1855-60. PMID: 16030024
  5. Sabate JM, Clotet M, Torrubia S, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics. 2007 Oct;27 Suppl 1:S101-24. PMID: 18180221
  6. White TT. Carcinoma of the breast and pregnancy; analysis of 920 cases collected from the literature and 22 new cases. Ann Surg. 1954 Jan;139(1):9-18. PMID: 13114847
  7. Yang WT, Dryden MJ, Gwyn K, Whitman GJ, Theriault R. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology. 2006 Apr;239(1):52-60. PMID: 16484353

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