Is this a new primary since path report states that it was breast tissue, or is it really chest wall recurrence? CT scan in Jan 2012 (after biopsy but before lumpectomy) states "mass right breast superficial to pectoralis muscle with deep aspect of mass abutting and potentially involving pectoralis muscle".

Discussion
Patient was originally diagnosed in June 2006, right breast; underwent lumpectomy, then chemo. 2nd mass was identified in right breast, so patient underwent bilateral mastectomy and reconstruction in Jan 2007 with no residual tumor in breast tissue and 1 positive right axillary lymph node. Patient started Arimidex in May 2007 and had ongoing follow up.

In 2010 patient found to have mediastinal lymphadenopathy but biopsy of mediastinal lymph node showed no malignancy.

In Nov 2011, patient noted 'lump to her right upper reconstructed breast at approximately 2:00'. Ultrasound confirmed mass and needle biopsy (Dec 2011) showed invasive carcinoma. Patient underwent lumpectomy and path report states "Breast tissue, right, lumpectomy: poorly differentiated infiltrating ductal cancer". There is no comparison of the current pathology to previous, as the previous lumpectomy/mastectomy was done at another facility.

Patient is being treated at our facility with radiation therapy as if this is a 'recurrent/persistent right sided-breast cancer'.

Answer
If the path report stated the tumor originated in residual breast tissue - new primary. If the path report says only chest wall and/or there is no designation of residual breast tissue, it is a regional metastases.

History


Last Updated
08/09/2012

Date Finalized
08/09/2012