What happened, in summary

A 46-year-old woman with no relevant prior medical history presented with a firm, painless lump in the upper quadrant of her right breast. The lump had enlarged slightly over 2 months, but she had no nipple discharge, weight loss, pain, or palpable axillary lymph nodes. Mammography showed 2 right-breast lesions: a 15 x 12 mm BIRADS 4 opacity in the lower inner quadrant and a 7 x 4 mm BIRADS 3 opacity in the upper outer quadrant. Ultrasound confirmed a polylobed hypoechoic lesion, and Tru-cut biopsy of the larger lesion was initially interpreted as SBR grade 2 infiltrating ductal carcinoma. The tumor was ER-negative, PR-negative, and HER2-negative. Biopsy of the smaller lesion showed adenofibroma. Thoraco-abdominal-pelvic CT showed no metastatic lesions. She underwent right mastectomy with homolateral axillary lymph-node dissection. The surgical specimen showed glands and trabeculae with vacuolated, foamy tumor cells and abundant PAS-positive, diastase-resistant secretions, leading to the final diagnosis of secretory breast carcinoma. An in-situ component was present, but there were no vascular emboli, perineural sheathing, nipple or skin infiltration, Paget disease, or lymph-node involvement. Repeat immunohistochemistry confirmed the triple-negative profile. Translocation testing was not performed because of financial constraints. She entered close medical surveillance after surgery rather than additional systemic treatment. Her disease was localized and node-negative, with no CT evidence of metastatic spread, so the clinical summary is localized, node-negative secretory breast carcinoma rather than metastatic cancer. The smaller adenofibroma was separate from the malignant lesion and did not drive treatment. At 2 years of follow-up, she had no local recurrence or metastasis.