A 53-year-old post-menopausal woman presented with left hip pain following minor trauma. Imaging revealed an osteolytic lesion in her left hip bone and soft tissue mass. Biopsy showed metastatic carcinoma of breast origin. Examination found a right breast lump with axillary lymphadenopathy. Immunohistochemistry of the breast tissue showed strong expression of estrogen receptor, progesterone receptor, and HER2 score of 3+. The patient received palliative radiotherapy and was prescribed endocrine therapy with trastuzumab and pertuzumab for HER2-positive metastatic breast cancer to the bone only.
1. Case presentation of metastatic
breast cancer
Fitting daily scenarios into
the context of guidelines
By
Ereny s. Poles
Ass.lecturer of clinical oncology
Assiut University
12/10/2017 breast cancer educational day
2. Lady patient 53 years old presented to trauma unit by acute left hip
pain following trivial trauma.
Plan X-ray was done.
12/10/2017 breast cancer educational day
3. MSCT pelvis revealed osteolytic bony lesion in lf neck of
fumer associated with soft tissue mass.
12/10/2017 breast cancer educational day
4. 12/10/2017 breast cancer educational day
Fixation and biopsy was done.
Pathological report: metastatic carcinoma mainly of breast origin .
Patient was referred to oncology clinic for further management.
5. Complete history and examination
Female patient 53 years old , married , post
menopausal with history of left hip fixation
with no other significant symptoms .
On clinical examination :
Patient was clinically free except for right breast
lump 2*3 cm hard , mobile with no skin changes
or nipple discharge but associated with multiple
ipsilateral axillary LNs largest 3*3 cm.
12/10/2017 breast cancer educational day
8. Further Investigation
1- Whole body MRI.
2- Chest X-ray , Abdominal US , bone scan.
3- CT Chest , abdomen , bone scan.
4- PET-CT.
12/10/2017 breast cancer educational day
9. 1- Whole body MRI.
2- Chest X-ray , Abdominal US , bone scan.
3- CT Chest , abdomen , bone scan.
4- PET-CT.
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12. Do we need biopsy from primary site
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13. • Intense and complete
immunostaining for
HER2 (score 3+) in
invasive breast
carcinoma. The normal
breast duct does not
show any membrane
staining.
12/10/2017
breast cancer educational day
Estrogen Receptor (ER) Testing
using IHC (brown).
Progesterone Receptor (PR) Testing
using IHC (brown). (x20)
15. So we have ……….
Female pt 53 years old post menopausal with
metastatic breast cancer to bone only as
further imaging was free.
Immunohistochemistry testing showed :
Strong ER , PR staining with HER2 neu score 3.
Patient received palliative radiotherapy on lf
hip joint .
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16. Wang Y, Romigh T, He X, et al. Differential regulation of PTEN expression by androgen receptor in prostate and breast cancers. Oncogene 2011; 30: 4327-
4338
12/10/2017 breast cancer educational day
17. YOU have to write prescription
1- AC*4 -----Taxane weekly *12 + Trastuzumab
followed by Trastuzumab+ AIs until progression.
2-AI s + Trastuzumab + Pertuzumab until
progression.
3- AIs + ERM ( fulvestrant ) or ERDG (everolimus) +
Trastuzumab + Pertuzumab until progression.
4- AIs + Palbociclib+ Trastuzumab + Pertuzumab
until progression.
12/10/2017 breast cancer educational day
21. Going for more controversies
Assuming that the patient had only one
site of bony metastasis ,
Would you change your
mind about her plan of
management
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22. KEEP YOUR EYES ON HER HEART
12/10/2017 breast cancer educational day
