Dados do Trabalho

Título

RECIDIVA DE CARCINOMA DUCTAL INFILTRANTE EM PLASTRAO DE MASTECTOMIA ESQUERDA DURANTE GESTAÇAO - RELATO DE CASO

Título em Inglês

RECURRENT INFILTRATING DUCTAL CARCINOMA IN LEFT MASTECTOMY PLASTRON DURING PREGNANCY: A CASE REPORT

Introdução

Breast cancer has the highest incidence, prevalence, and mortality rate among malignant neoplasms in women, worldwide (excluding non-melanoma skin cancer). Although there are well-defined treatments, they are still controversial in pregnancy: surgery seems safe and chemotherapy (QT) poses no harm to the fetus, especially if applied late in pregnancy. Hormone therapy and radiation therapy (RT) are prone to cause fetal damage. In patients who diagnose pregnancy during treatment, there are no clear procedures about terminating the pregnancy or ceasing QT and RT. In these cases, it is necessary to monitor the patient and the fetus - taking into account the woman's will - especially if the tumor has estrogen and progesterone receptors, increasing the chance of relapsing or stop responding to QT. This study reports a case in which the hormones of pregnancy influenced a major recurrence of breast cancer, which diminished shortly after the birth.

Relato de caso

35-year-old woman, diagnosed with infiltrating ductal carcinoma in the left breast, underwent sectorectomy, axillary lymph nodes excision, and RT with an insufficient response. Subsequently, left tumor recurrence arose and mastectomy was performed. In the follow-up, she did QT and RT, with poor response. In the interim, it was discovered that the patient was pregnant, thus referred from oncology to gynecology for the interruption, since there was a considerable recurrence in the left breast plastron. Sixth gravida, with five vaginal deliveries, the latest one six years ago, all without complications. She was counseled about termination but remained adamant in maintaining the pregnancy. She performed an obstetric ultrasound, with a viable fetus of six weeks and six days of gestational age (GA). At 22 weeks of pregnancy, she was referred to the hospital by the oncologist, for the interruption. As the plastron on the left breast was growing, with QT failure. The patient acknowledges that, with this GI, the fetus's chance of survival was meager. Yet, she opted for maintenance. Later, she was sent, by the prenatal care, to the maternity hospital at 32 weeks of GA, aiming at delivery and a new QT protocol afterward. She underwent corticosteroids for pulmonary development of the conceptus and endured cesarean delivery with bilateral adnexectomy. Female newborn, 1.830g, 8/9 APGAR score and 32 weeks and 5 days Capurro, transferred to the neonatal ICU due to prematurity. The patient was evaluated few months after delivery: Great spontaneous resolution of the plastron in the left breast, with no effect of pregnancy hormones and responsive to QT. Follow up with oncology.

Palavras Chave

Câncer; Carcinoma Infiltrante de Mama; Mastectomia; Recidiva; Gestação;

Área

TREATMENT - Pregnancy-associated breast cancer