July- December 2012 pdf for website

Synchronous bilateral invasive breast carcinoma
1 2 2

Chikhlikar Kasturi , Wilkinson Anne , Bothale Kalpana

Abstract:

Bilateral breast carcinomas are uncommon lesions, with most evidence supporting them to be independent

tumours and not metastatic tumours. Synchronous breast carcinomas are carcinomas which arise within 3 months

from the diagnosis of the first tumour. We report a case of synchronous bilateral breast cancer in a 32-year-old lady.

Keywords: Synchronous, Breast carcinoma.

Case history:

A 32- year-old lady presented with a 4 x 3 cm right
breast hard lump of 4 months duration, with palpable right
axillary lymph nodes. The left breast was apparently normal.
There was no family history of breast cancer. FNAC of the right
breast lump diagnosed a ductal carcinoma and the subsequent

right mastectomy specimen showed infiltrating duct
carcinoma NOS, Grade II with areas of mucinous carcinoma
and metastases to five axillary lymph nodes (Fig. 1 and 2).
After surgery a week later while still in the hospital, she noticed
a small lump in the contralateral left breast, which was a
mobile 1 x 1 cm lump. No left axillary lymph nodes were

Figure 4:
Photomicrograph showing left breast infiltrating duct
carcinoma

Figure 1:
Gross photograph of right mastectomy specimen showing a
white infiltrative growth with mucinous areas (left)

Figure 2:
Photomicrograph showing right breast infiltrating duct
carcinoma and mucinous carcinoma areas

Figure 3:
Gross photograph of left mastectomy specimen showing a
white infiltrative growth

1 2
Pathology Resident, Associate

Professor, Department of Pathology,
NKPSIMS & RC, Digdoh Hills, Hingna
Road, Nagpur -440019.
anne_cerry@yahoo.co.in

PJMS- Volume 2 Number 2: July- December 2012

Case Report

palpable. FNAC of this mass showed presence of benign ductal
cells, and cells with suspicion of malignancy. A lumpectomy
was done which showed areas of intraductal and lobular
hyperplasia and a small focus of intraductal carcinoma. The
subsequent mastectomy specimen showed Infiltrating duct
carcinoma NOS, Grade II with metastasis in two left axillary
lymph nodes (Fig. 3 and 4). The patient was referred to the
oncologist for further treatment.

Discussion:

Breast cancer is one of the most important health
problems in the world and affects a great number of women
over the entire globe (1). Bilateral breast carcinoma is a rare
clinical entity. These are of two types- Synchronous and
Metachronous. Majority are metachronous with an incidence
of 5-6% whereas synchronous have an incidence rate of 0.2-2
% (2). Synchronous breast carcinomas are carcinomas which
arise within 3 months from the diagnosis of the first tumour
(3). Most evidence supports bilateral breast carcinomas to be
independent tumours and not metastatic tumours. When
cancer is detected in the opposite breast, however, the
question arises whether this tumour is a second cancer or a
metastatic spread from the ? rst breast cancer. A
differentiation based on clinical and histopathological
parameters de?nes a second primary, when either in situ
lesions, a different histological type or a higher degree of
histological differentiation can be demonstrated in the second
cancer (4). In our case the fact that the second tumour also
showed areas of hyperplasia and intraductal carcinoma in
addition to invasive malignancy, supports the fact that this was
an independent tumour and not a metastasis. The gradual
increase in the incidence of synchronous disease during the
1970s coincides with the introduction of routine and bilateral
mammography as part of the diagnostic work-up in women
with unilateral cancer (2). Such work-up may entail that some
preclinical bilateral cancers are detected early and classi?ed as
synchronous disease (perhaps in an earlier and more
favourable stage) rather than diagnosed later as
metachronous disease (5).

Family history plays an important role in the
pathogenesis of bilateral breast carcinoma. Women with a
first-degree relative whose breast carcinoma was diagnosed at
an early age have a higher risk of developing bilateral breast
carcinoma. There are numerous reports in the literature
purporting to document the occurrence of unilateral and
bilateral breast carcinomas in young women treated with
irradiation for postpartum mastitis, Hodgkin disease,
tuberculosis, and others diseases(6).

There are high rates of distant metastases for
synchronous bilateral breast cancer and the prognosis is worse

than metachronous breast carcinomas (7). However
contradictory data exists concerning the prognosis of patients
with synchronous bilateral breast cancer (SBBC). Schmid et al
(8) found that the prognosis of SBBC (synchronous bilateral
breast cancer) was determined by the reference lesion; the
contralateral second tumor had no additional impact on
outcome. However Solh et al (9) found synchronous breast
cancer to be more aggressive than metachronous breast
cancer with a poorer outcome.

Importance:

The early presentation and detection of the second
malignancy while the patient was still recovering from the first
surgery makes this a very interesting case of synchronous
bilateral invasive breast carcinoma.

References:

1. De'Mello R, Figueiredo P, Marques M, Sousa G, Carvalho T,
Gervasio H. Concurrent breast stroma sarcoma and breast
carcinoma: A case report. Journal of Medical Case Reports
2010; 4: 414.

2. Dalal AK, Gupta A, Singal R, Dala U, Attri AK, Jain P, et al.
Bilateral breast carcinoma– A rare case report. J Med Life 2011;
4(1): 94–96.

3. Shi YX, Xia Q, Peng RJ, Yuan ZY, Wang SS, An X, et al. Comparison
of clinic-pathological characteristics and prognoses between
bilateral and unilateral breast cancer. J Cancer Res Clin Oncol
2012; 138(4):705-14.

4. Janschek E, Eckersberger DK, Ludwig C, Kappel S, Wolf B,
Taucher S, et al. Contralateral breast cancer: Molecular
differentiation between metastasis and second primary
cancer. Breast Cancer Research and Treatment 2001; 67:1–8.

5. Hartman M, Czene K, Reilly M, Adolfsson J, Bergh J, Adami H, et
al. Incidence and Prognosis of Synchronous and Metachronous
Bilateral Breast Cancer. Journal of Clinical Oncology 2007; 25
(27): 4210-4216.

6. Heron DE, Komarnicky LT, Hyslop T, Schwartz GF, Mansfield
CM. Bilateral breast carcinoma. Cancer 2000; 88 (12): 2739-
2750.

7. Vuoto HD, García AM, Candás GB, Zimmermann AG, Uriburu JL,
Isetta JA, et al. Bilateral breast carcinoma: Clinical
characteristics and its impact on survival. Breast J 2010; 16(6):
625-32.

8. Schmid SM, Pfefferkorn C, Myrick ME, Viehl CT, Obermann E,
Schötzau A, et al. Prognosis of early-stage synchronous
bilateral invasive breast cancer. Eur J Surg Oncol 2011 Jul;
37(7):623-8.

9. Solh M, Ali HB, Mittal V, Bergsman K. Synchronous versus
metachronous breast cancer: Characteristics of the second
tumour. J Clin Onco 2008; 26 May (suppl): 1107.

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Case Report

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