What happened, in summary

An 82-year-old woman had a history of cancer in her right breast diagnosed 18 years before the current case. That earlier tumour included invasive ductal carcinoma and ductal carcinoma in situ. It was classified as T1aN0 and described as triple-negative. She underwent a right mastectomy with TRAM-flap reconstruction, along with a left breast lift during the same operation. No chemotherapy, radiation, hormone therapy, or other adjuvant treatment was given for the right-sided cancer. Nearly two decades later, she presented with a new palpable mass in the opposite breast. The later left breast tumour was evaluated as a separate primary rather than a recurrence or metastasis from the earlier right-sided cancer. The later left tumour had different histology from the earlier right cancer and was considered a new contralateral primary. The historical right cancer had been managed by mastectomy alone, while the later left lesion was a metaplastic carcinoma with osteoblastic differentiation. Her history therefore included two distinct breast cancers separated by 18 years.