Rapidly enlarging tumor in the middle of the chest with no lump in the breast and bilateral axillary lymph nodes. Tru-cut revealed it to be an IDC.
I need more information to answer this question. Has the patient had an MRI to look for occult breast lesions? Has she had breast cancer previously? She will need staging studies, including Chest/abd CT or PET/CT scanning to rule out sternal metastasis or internal mammary lymph node metastasis eroding up toward the skin. The axillary lymph nodes should be examined by ultrasound and abnormal nodes should be biopsied by U/S guided FNA or core-needle biopsy. Could the mass in the middle of the chest actually be in a very medial part of the breast rather than between the breasts?
MRI did not show any lesions in the breasts. PET showed a mass in the middle of the chest without any uptake in the breast. Bilateral axillary LN showed uptake (SUV; 2.8)
- I would assume an indeterminate primary lesion (occult breast) and manage her loco- regional disease with excision to clear margins (central chest lesion only) and axillary clearance (if biopsy proven positive LN's).
- Adjuvant regional/ systemic therapy would be determined by her prognostic criteria on her histopathology/ bio-markers.
- Closure of her defect may require a local perforator/ advancement flap.
- Close surveillance imaging follow-up would be appropriate.
Ultimately her prognosis will be defined by systemic relapse. With no clear indication as to the primary, I am unable to see the benefit of 'prophylactic surgical intervention' i.e. mastectomy. Hope this is usefull
We managed her with NACT, to which the tumor responded well. After that we carried out a WLE with B/L axillary dissection and gave RT to the tumor bed. As the tumor was hormone receptor positive, we have started her on Letrozole.
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