Images in Clinical Medicine

Rapid Progression of Basal-Type Breast Cancer

Victoria L. Seewaldt, M.D., and Victoria Scott, M.S.

N Engl J Med 2007; 356:e12March 29, 2007

• Slide

Article

A 33-year-old woman with a known BRCA1 mutation (2080delA) was referred for 3.0-tesla magnetic resonance imaging (3T MRI). The patient's mother had had breast cancer at the ages of 31 and 38 years; her sister had had breast cancer at the age of 30. Routine physical examination revealed no breast masses, and screening mammography showed extreme breast density but was otherwise normal. At follow-up approximately 4 months later, 3T MRI showed a progressively enhancing lesion, 1.6 by 1.0 cm (Panel A, arrow). Mammographic imaging showed new calcifications at the 10 o'clock position. A stereotactic biopsy was performed; 4 of 10 cores showed calcifications, and all cores showed ductal hyperplasia with no evidence of cancer. Approximately 1 year later, repeated 3T MRI showed a peripherally enhancing mass, 4.7 by 6.1 by 5.3 cm, extending to the pectoralis muscle, with extensive neovascularization (Panel B, arrow). A biopsy specimen showed the presence of an invasive adenocarcinoma of the breast, which was classified as grade II to III, with a negative test for estrogen receptor, at 0 fmol per milligram, and a borderline-positive test for progesterone receptor, at 13 fmol per milligram. The biopsy specimen was HER2/neu-negative and cytokeratin 5/6–positive, findings that were consistent with the presence of a basal-type breast cancer. The patient chose to receive further care from a local oncologist.

The BRCA1 mutation is associated with ovarian cancer as well as breast cancer. The sensitivity of mammography is decreased in women with high breast density. Therefore, close follow-up with more sensitive screening approaches, such as MRI, in women at high risk for breast cancer, such as those with the BRCA1 mutation, is warranted.

Victoria L. Seewaldt, M.D.
Victoria Scott, M.S.
Duke University, Durham, NC 27710
seewa001@mc.duke.edu

Citing Articles (9)

Citing Articles

1. 1

   J Wang, P S Ray, M-S Sim, X Z Zhou, K P Lu, A V Lee, X Lin, S P Bagaria, A E Giuliano, X Cui. (2012) FOXC1 regulates the functions of human basal-like breast cancer cells by activating NF-κB signaling. Oncogene
   CrossRef

2. 2

   E.A. Rakha, S. Chan. (2011) Metastatic Triple-negative Breast Cancer. Clinical Oncology 23:9, 587-600
   CrossRef

3. 3

   Christian S. Adonizio, Genorosa Grana, Kanu Sharan, Lewis Rose, Allison Zibelli, Susan Miller-Samuel, Gloria J. Morris. (2010) Recurrent Early-Stage Triple-Negative Breast Cancer. Seminars in Oncology 37:5, 419-428
   CrossRef

4. 4

   Aye Aye Thike, Jabed Iqbal, Poh Yian Cheok, Angela Phek Yoon Chong, Gary Man-Kit Tse, Benita Tan, Patrick Tan, Nan Soon Wong, Puay Hoon Tan. (2010) Triple Negative Breast Cancer: Outcome Correlation With Immunohistochemical Detection of Basal Markers. The American Journal of Surgical Pathology 34:7, 956-964
   CrossRef

5. 5

   Rebecca Dent, Wedad M. Hanna, Maureen Trudeau, Ellen Rawlinson, Ping Sun, Steven A. Narod. (2009) Pattern of metastatic spread in triple-negative breast cancer. Breast Cancer Research and Treatment 115:2, 423-428
   CrossRef

6. 6

   Emad A. Rakha, Maysa E. El-Sayed, Jorge Reis-Filho, Ian O. Ellis. (2009) Patho-biological aspects of basal-like breast cancer. Breast Cancer Research and Treatment 113:3, 411-422
   CrossRef

7. 7

   Oluwole Fadare, Sa A. Wang, Denise Hileeto. (2008) The expression of cytokeratin 5/6 in invasive lobular carcinoma of the breast: evidence of a “basal-like” subset?. Human Pathology 39:3, 331-336
   CrossRef

8. 8

   Oluwole Fadare, Fattaneh A Tavassoli. (2008) Clinical and pathologic aspects of basal-like breast cancers. Nature Clinical Practice Oncology 5:3, 149-159
   CrossRef

9. 9

   Oluwole Fadare, I-Tien Yeh. (2007) Basal-Like Breast Cancers. Pathology Case Reviews 12:4, 143-153
   CrossRef