Case history
Case history #1
A 60-year-old woman presents after feeling a lump in her right breast. Mammogram confirms a lesion in the area of the palpable mass. The patient is referred to a surgeon, who performs a physical examination, which is otherwise negative. Core biopsy of the lesion demonstrates ductal carcinoma. Excisional biopsy and axillary evaluation are performed, with one lymph node containing invasive duct carcinoma. Computed tomography scan of the chest and abdomen and bone scan are performed. Two lesions are identified in the lung, consistent with metastases.
Case history #2
A 52-year-old woman presents with an abnormal left mammogram. Stereotactic biopsy demonstrates invasive ductal carcinoma. Excision of the cancer leaves negative margins, and lymph node evaluation does not demonstrate disease spread to the axilla. Three years after initial treatment, the patient presents complaining of pain in her lower left rib and denies trauma. Bone scan demonstrates multiple rib lesions, consistent with disease spread to the rib. The remainder of the metastatic workup is negative. Complete blood count and liver panel are normal except for alkaline phosphatase, which is elevated.
Other presentations
MBC presents heterogeneously. Patients may have synchronous locoregional and metastatic disease, or the locoregional disease may have been treated for cure, with metastases presenting at a later time. In general, disease limited to bone and/or soft tissue has a more indolent course than visceral metastases, and the longer the disease-free interval between treatment of the primary breast cancer and the diagnosis of metastases, the more favorable the outcome.[3]
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