Stage 3 infiltrating ductal carcinoma treated with radical mastectomy

What happened, in summary

A 55-year-old man presented with a palpable right breast mass that had been increasing in size for 4 months. He had no reported history of alcohol, tobacco, or illicit drug use and no known family history of breast or ovarian cancer, although his mother had cervical and lung cancer. Office sonogram showed a 2.8 cm irregular, highly suspicious mass at the 10 o'clock position. Core biopsy confirmed invasive ductal carcinoma, grade 2 of 3, involving all 6 biopsy cores. He underwent right radical mastectomy with sentinel lymph node mapping. During surgery, 2 hard, indurated right axillary lymph nodes were removed; frozen section showed metastatic carcinoma, so the operation proceeded to complete axillary dissection. Final pathology showed infiltrating ductal carcinoma, grade 2, with a 4.7 cm tumor, direct invasion of the dermis or epidermis without skin ulceration, negative surgical margins, and pathologic stage pT2 pN2a, consistent with Stage III disease. A total of 21 lymph nodes were removed, and 3 contained macrometastatic carcinoma. Immunohistochemistry showed ER positivity, PR positivity, Ki-67 positivity, and HER2 negativity. Genetic testing found a heterozygous pathogenic MUTYH c.1187G>A (p.G396D) variant and a heterozygous BARD1 c.1339C>G variant of uncertain significance. Her postoperative recovery was described as free of surgical complications, but endocrine therapy, chemotherapy, radiation, and longer-term recurrence status were not reported. The case text also described tracer localization during sentinel-node mapping, but the suspicious nodes lacked counts, likely because tumor infiltration blocked lymphatic flow, prompting more extensive axillary surgery.