Case • 48 y.o. healthy woman • Right breast mass present for 4 weeks • No other known health problems • Clinical breast examination: – Fullness visible in R breast w/o skin changes – 3.5cm palpable mass R upper outer quadrant – Palpable R axillary lymph node
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Case 48 y.o. healthy woman Right breast mass present for 4 weeks No other known health problems Clinical breast examination: –Fullness visible in R breast.
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Case
• 48 y.o. healthy woman
• Right breast mass present for 4 weeks
• No other known health problems
• Clinical breast examination:– Fullness visible in R breast w/o skin changes– 3.5cm palpable mass R upper outer quadrant– Palpable R axillary lymph node
RIGHT 9 O’CLOCK PALPABLE
RIGHT LEVEL 1 AXILLA ABNORMAL LN
Imaging Results
• Right breast 9 o’clock– Irregular mass– Maximum dimension 52 mm
• Right axilla– Multiple abnormal lymph nodes
RIGHT 9 O’CLOCK US BIOPSY
RIGHT 9 O’CLOCK US BIOPSY MARKER CLIP
RIGHT AXILLARY LN US BIOPSY
Histopathology Results
• Right breast 9 o’clock– IDC – Nottingham II/III– ER+/PR+, Her2 neg by FISH– Ki67 50%
• Right axilla– LN with metastatic IDC
BASELINE MRI
RIGHT 9 O’CLOCK KNOWN IDC RIGHT LEVEL 1 AXILLA KNOWN METASTATIC LAN
LEFT 3 O’CLOCK NMLE 23 MM MRI BX = DCIS
Staging Studies
• CT C/A/P: no distant metastases
• Bone scan: no distant metastases
Treatment Options
• Surgery?
• Radiation Oncology?
• Medical Oncology?
2/09 Clinical MRI 3/09 MRI after 1 week sunitinib
6/09 MRI after 12 weeks sunitinib/paclitaxel
10/09 MRI after 15 weeks doxorubicin/cyclophosphamide