I have 38 old fm patient. Family history (+). 3 years ago we perfomed bilateral risk reduction mastectomy after a diagnosis of LCIS. Mastectomy was done with nipple sparing technique and retromuscular Becker prothesis. the follw up was uneventful until 1 month ago. Patient had a skin rash at his left breast inner quadrant. The biopsy of this area confirmed a invasive ductal tumor. The area contains 1/3 of his breast and have extension to the other breast .
do you prefer Surgery or a neoadjuvant chemo ?
should we the prothesis take don
Dear Yenlay
Please inform us regarding axillary status and IHC of tumor ignorer to decide about treatment plan.
Best Regards
Mahmoodzadeh habibollah
Dear Dr Mahmoodzadeh,
Tumor is ER (+) and one suspicious lymph node in axilla and one in mediastinum according to PET-CT
Dear Dr Yeniay
i suggest first FNA from suspected lymph node in axilla and if node is positive (involved)
axillary dissection is the next step.
the involved skin should be resected (wide local excision) and then radiotherapy and finally endocrinotherapy with tamoxifen
i suppose your staging work uo is complete and there is no other metastasis.
good luck
Habib
Dear Yeniay,
Difficult case. I think i would do wide local excision and axillary dissection. Prothesis can be left in the breast. Even if no involved lymph nodes after axillary dissection, chemo should be considered since the patient is very young. In the case case of negative axilla, i am not very sure if radiotheraphy is needed but radiation oncologysts would probably want to give radiotheraphy since suspicion of mammaria interna involving on Pet scan.
Good luck
Last weeks we have began a chemo to the patient. I'll give information about the progress after chemo treatment.
Thanks to colleges that share knowledge with me
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