Stage I ER-positive PR-negative breast cancer: disease-free after lumpectomy, radiation and tamoxifen

What happened, in summary

A 48-year-old peri-menopausal woman presented with a painless, gradually growing lump in the upper inner quadrant of her left breast and 2 months of intermittent spontaneous bloody nipple discharge. Examination found a firm 2 x 2 cm lump near the nipple-areolar complex with skin tethering but no palpable axillary lymphadenopathy. Mammography and ultrasound showed a suspicious multicentric left breast tumor, with a main 15 x 8 mm lesion and 2 satellite lesions. Clinical staging was cT1(m)N0M0. Core biopsy showed grade 1 invasive breast carcinoma of no special type. Biomarker testing showed ER positivity in 60% of tumor cells, PR negativity, HER2/neu negativity, and Ki-67 of 5%. She chose breast-conserving surgery with reconstruction rather than bilateral reduction mammoplasty. The operation included wire-guided bracketing of the satellite lesions, wide local excision including the nipple-areolar complex, sentinel lymph node biopsy, and MICAP flap reconstruction. About 30% of the breast volume was removed, and specimen mammography confirmed clear margins around the tumor and satellite lesions. Final pathology showed infiltrating ductal carcinoma, grade 1, with 3 invasive foci, the largest measuring 1.8 cm. All margins were negative, and 0 of 6 lymph nodes were positive. She had no postoperative complications and was discharged on postoperative day 2. The multidisciplinary team recommended adjuvant radiotherapy and tamoxifen planned for 10 years. At 15 months after surgery, she remained disease-free, had no complaints, and was very satisfied with the surgical outcome. The reconstruction was designed to preserve breast contour after removal of the central tumor and nipple-areolar complex.