Table 1.
Patient characteristics
| Patient | 1 | 2 | 3 |
|---|---|---|---|
| Age, years | 48 | 98 | 56 |
| Reason for consultation | painful nodule in the contralateral breast during follow-up of a benign lump in the affected breast | fast-growing nodule in breast, enlargement accompanied by skin changes | derived from the screening program due to a BI-RADS 3b1 by nodule or mass |
| Clinical examination | palpable nodule of 1.5 cm, regular, medium consistency, located in the upper external quadrant (already known); no tangible lymphadenopathy | increased breast size, tension; a nodule of soft consistency is palpable and occupies the entire breast, with signs of inflammation in the skin, which is thin and fragile and has increased vascularity | palpable nodule is hard, mobile, with well-defined consistency; greater than 1 cm |
| Mammography | dense pattern, patchy, pseudonodular; nodules in both breasts, 1 in the upper external quadrant, retroareolar in affected breast; multiple bilateral scattered microcalcifications with benign characteristics | not made | mixed radiological pattern; predominance of glandular tissue of medium density with benign nodules; characteristics affect breast where there is also a faint increase in density in the upper external quadrant |
| Ultrasound | solid and polylobed nodule of 22 ′ 13 mm, located in the upper external quadrant, probably benign (BI-RADS 3); UGB was performed because not described in previous studies; bilateral simple cysts | very heterogeneous pattern with destruction of normal ultrasound breast pattern; mainly consisting of cystic areas having multiple echoes inside low impedance with anfractuous walls and increased peripheral vasculature, affecting all quadrants of the breast both in depth and surface | solid or mixed node of 15 ′ 13 mm in affected breast in the upper external quadrant, very indefinite contours, with peripheral vasculature, shadow interface and irregular subsequent reinforcement; subcentimeter simple bilateral cysts |
| MRI | cancerous nodule in union of upper quadrantsof 23 mm; no involvement of skin, nipple or chest wall; ipsilateral axilla and normal mammary chains; 6 MRI BI-RADS unifocal | MRI not indicated by the advanced age of the patient and the indication of total mastectomy simple | single cancerous nodule of 15 mm in union of upper quadrants; nipple, skin, chest wall and ipsilateral axilla are normal; normal mammary chain; 6 MRI BI-RADS unifocal |
| Hormonal factors (estrogen and progesterone) | Negative | negative | estrogen: weakly positive (3%); progesterone: negative |
| Prognostic factors Surgical treatment | p53: positive 60%; HER2: negative; Ki-67: positive 40%; CK-19: positive lumpectomy + SLNB | p53: positive 10%; HER2: negative; Ki-67: positive 40%; CK19: negative total mastectomy simple | p53: positive 30%; HER2: unknown ++; Ki-67: positive 50%; CK19: negative lumpectomy + SLNB |
| Histopathology | SLN: negative; lumpectomy: metaplastic carcinoma with chondroid mesenchymal differentiation; unifocal; poorly differentiated, grade III; resection margins respected; immunohistochemical study of hormone receptors and prognostic factors identical to the core needle biopsy | metaplastic carcinoma with myoepithelial differentiation with infiltration of all breast quadrants; infiltration of skin and nipple areola complex with neoplastic cells; perineural infiltration without apparent vascular invasion; extensive necrosis | sentinel node (′ 2): negative; lumpectomy: poorly differentiated infiltrating ductal carcinoma, grade III, with focal component of metaplastic carcinoma with chondroid differentiation; preserved surgical margins; immunohistochemical study of hormone receptors and prognostic factors identical to the core needle biopsy; no amplification of the HER2/neu gene studied by SISH |
| Stage | pT1c N0 (0/2 sn) M0 | pT3NxMx | pT1c pN0 (0/2 sn) M0 |
| Adjuvant therapy | adriamycin-adjuvant cyclophosphamide every 3 weeks for 4 cycles followed by taxol weekly for 8 weeks; after chemotherapy 3D external radiotherapy is performed at 50 Gy + 16 Gy | no adjuvant therapy is given due to the advanced age of the patient | adriamycin-adjuvant cyclophosphamide every 3 weeks for 4 cycles followed by taxol weekly for 8 weeks; after chemotherapy 3D external radiotherapy is performed at 39.9 + 13.3 Gy |
BI-RADS = Breast Imaging Report and Data System, UGB = ultrasound-guided breast biopsy, MRI = magnetic resonance imaging, HER2 = human epidermal growth factor receptor 2, CK = cytokeratin, SLNB = sentinel lymph node biopsy, SISH = silver in situ hybridization, 3D = 3-dimensional.