Breast Conference Presentation

Triple Negative Breast Cancer

Niloy Chatterjee, MS-3
Patient:

W.H. (born 10/20/1979)

CC:

W.H. is a 35-year-old African American female who presented to Dr. P and Dr.
R for a second opinion of her recent diagnosis of triple negative breast
cancer (T2 N0 M0) on April 2nd, 2015. She was previously in the Kaiser
Permanente system. She is status post neoadjuvant therapy with 2
regiments; Cisplatin and Paclitaxel therapy, and Adriamycin and Cytoxan
therapy, both without any clinical improvement.

HPI/Tests: About seven months ago, the patient felt an abnormality in the upper outer
quadrant of her right breast. She then received a bilateral screening
mammogram that yielded abnormal findings in the right breast and normal
findings in the left breast. She subsequently underwent a diagnostic
mammogram and ultrasound of the right breast. The radiology report stated
the following:

CAD assisted Diagnostic mammogram showed cystic changes in the

upper outer quadrant of the right breast. Underlying masses were
seen at the 10 and 12 oclock positions. The larger and more
peripheral mass measured 3cm and more the central mass measured
1.7cm, which corresponded to the palpable findings the patient had
during physical exam. The margins were noted to be more lobular
than expected for a benign lesion like a fibroadenoma. No axillary

lymphadenopathy was seen.

Ultrasound of the right breast showed several simple cysts, the largest
at the 9 oclock position, 5cm from the nipple, measuring 2cm. At the
12 oclock position, also 5cm from the nipple, a relatively well-defined
1.8cm mass was seen, but with multiple small lobulations, some with

acute angles. Minimal internal blood flow was noted.

She was given a BIRADS code of 4, and was recommended for a biopsy
of the clinically palpable 1.8cm mass at the 12 oclock position.

Biopsy??? Triple Negative Breast Carcinoma

Treatment: She was then started on a weekly neoadjuvant regiment of
Paclitaxel and Carboplatin; 10 weeks of Paclitaxel along with three doses of
Carboplatin. Patient stated that there was a delay in her treatment regiment
due to developing neutropenia. Her last dose regiment was on February 19th,
2015. It was found that the patient did not respond to her treatment and
was subsequently put on Adriamycin and Cytoxan along with Neupogen to
assist WBC production. At that point the patient left the Kaiser system and
was referred to Dr. Phillips, who has continued the patient on the Adriamycin
and Cytoxan. The last cycle was administered on April 27th, 2015.
Other Tests:

Genetic Testing: negative for BRCA-1, BRCA-2, CDH1, PTEN and pt53.

Bone Marrow Biopsy: mildly hypercellular marrow with no evidence of

malignancy
Echo: normal ejection fraction of 66-69%
Surgical Hx:

Port Placement

Family Hx: Mother died in her 40s due to breast cancer. Maternal grandmother had
colon cancer.
Pregnancies:

No children; 4 total pregnancies (1 stillbirth, 1 miscarriage, 2 elective

abortions)
Meds:

Adriamycin IV, Cytoxan IV, Prednisone, Oxycodon, Ondansetron

Allergies: Niacin
Vitals:

As of 05/08/2015:

Plan:

Ht: 511
Wt: 216
BMI: 30.13
BP: 129/68
HR: 75bpm

It was recently determined that the adjuvant therapy with Adriamycin and
Cytoxan was not clinically shrinking the cancer. After a lengthy discussion
with the patient, it was decided to move forward with surgery. She opted for

a mastectomy without reconstruction at this time. She needs to be

scheduled for a PET scan, and another office visit to both discuss the PET
scan results and to do a preop workup. After the surgery, the patient will
need radiation therapy. It has also been discussed to introduce the patient to
a breast cancer survivor.