Stage IIA ER/PR-positive mucinous breast cancer: tamoxifen plus cryoablation with no recurrence

What happened, in summary

An 88-year-old woman noticed a painless lump in her left breast. Examination found a mobile, non-tender nodule at the 5 o'clock areolar margin, with no skin changes, nipple abnormalities, or palpable lymphadenopathy. Ultrasound showed a 2.2 cm lobulated hypoechoic nodule with internal cystic areas and vascularity, and mammography showed a subareolar nodular density without microcalcifications or architectural distortion. CT and bone scan excluded regional or distant metastases. The cancer was clinically staged as cT2 cN0 cM0, Stage IIA. Core biopsy showed invasive mucinous carcinoma, strongly ER-positive and PR-positive, both 100% at 3+, and HER2-negative. Because of the favorable hormone-receptor profile, she started tamoxifen. Surgery was initially discussed, but her moderate-to-severe aortic stenosis, frailty, recurrent COVID-19 infections, and anesthesia risk made operative treatment unsafe, and she and her family declined surgery and axillary staging. After multidisciplinary discussion, she underwent percutaneous cryoablation under local anesthesia. Hydrodissection displaced the superficial tumor away from the dermis, and a cryoprobe was used for 2 controlled freeze-thaw cycles. She had no immediate complications, went home the same day, and continued tamoxifen. Follow-up ultrasound and mammography at 6 months, 1 year, 2 years, and 3 years showed progressive shrinkage of the treated area into a less distinct scar-like region measuring 0.7 cm at about 32 months. Clinical examination, imaging, and tumor markers showed no recurrence in either breast, axillae, or distant sites, and she remained asymptomatic. She adhered well to tamoxifen and routine follow-up, and the palpable abnormality resolved within the first year after ablation.