CONTRASTING OUTCOMES IN BILATERAL HORMONE POSITIVE BREAST CANCER: COMPLETE PRIMARY TUMOUR REGRESSION WITH PERSISTENT NODAL METASTASIS
2 Department of Radiology, University of Maiduguri, Maiduguri, Borno State, Nigeria; Department of Clinical Oncology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
3 Department of Histopathology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
4 Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
* Corresponding author: cinc472@gmail.com
Abstract
Introduction: Bilateral breast carcinoma (BBC) is an uncommon but clinically significant condition, with an incidence ranging from 1.4% to 12%. It can present synchronously or metachronously and poses diagnostic and therapeutic challenges due to its rarity and heterogeneous biological behavior. Complete primary tumor regression refers to the complete disappearance of the primary tumor at the site of origin in response to treatment with no detectable cancer cells remaining either clinically, radiologically or pathologically.
Case Presentation: We present the case of a 56-year-old postmenopausal woman who presented with complaint of right breast lump and bilateral axillary lymphadenopathy which was incidentally detected during routine screening. Initial biopsy confirmed hormone receptor positive and Human Epidermal Growth Factor Receptor-2 (HER-2) negative status. Imaging revealed Breast Imaging Reporting and Data System (BIRADS)-6 in both breasts, yet a pre-treatment biopsy of the left breast was not performed due to the absence of a palpable mass. The patient received neoadjuvant chemotherapy and thereafter bilateral modified radical mastectomy. Postoperative histopathology showed no residual tumor in either breast but revealed metastatic disease in 2 of 5 sampled lymph nodes from the left axilla, which were also hormone receptor positive and HER2-negative. These findings raised two possible diagnoses: (1) synchronous bilateral hormone receptor positive breast cancer with complete primary tumor regression and residual nodal disease or (2) right-sided primary with contralateral axillary metastasis (CAM).
Conclusion: The case illustrates a rare scenario of complete bilateral primary tumor regression with persistent nodal metastasis, highlighting the unpredictable nature of hormone receptor-positive breast cancers. It emphasizes the need for meticulous assessment of both breasts and lymphatic regions, especially in patients with bilateral lymphadenopathy, to ensure accurate diagnosis and optimal therapeutic planning. It also contributes to the limited literature on such complex presentations from Sub-Saharan Africa.
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