The endless fight against breast cancer Department of Hemato-Oncology R2 최인아 / Prof 김시영

Admission Note CC. Lt breast palpable mass o/s 1 달 전 PI. F/49 1 달 전 우연히 촉지되는 좌측 유방 종괴 발견하여 있어 암 검진 위해 본원 외과 외래 방문함. 외래에서 시행한 breast sono 와 mammography 에서 악성종양 의심되어 수술적 치료 위해 입원 윤 0 숙 F/49 Adm :

PMHx: DM/HTN/Tb/Hepatitis (-/-/-/-) OP Hx: 20 년 전 C/sec PHx: smoking(-) alcohol(-) menopause (-) Admission Note

Review of System General fatigue (-) febrile sense (-) chilling (-) myalgia (-) night sweating (-) Skin rash (-) itching (-) pigmentation (-) Respiratory cough (-) sputum (-) tachypnea (-) Cardiac chest pain (-) palpitation (-) orthopnea (-) Gastrointestinal swallowing (-) jaundice (-) abdominal pain (-) A/N/V/D/C (-/-/-/-/-)

Physical Examination Vital sign 120/80mmHg – 80/min- 20/min- 36.5’C General alert mentality not so ill looking appearance Head & Neck cervical LN enlargement (-) Thorax symmetrical chest expansion clear breathing sounds at both lung field regular heart beat without murmur Abdomen soft & flat abdomen normoactive bowel sound tenderness (-) rebound tenderness (-)

Physical Examination irregular hard fixed mass Breast symmetry (+) ill defined hard, fixed mass axillary LN enlargement (-)

Mammography ( )

Breast sono ( ) → Core biopsy : infiltrating ductal ca Lt 2:30 4cm RUO RAD

Impression # 1. breast ca, Lt # 1. paipable mass, Lt breast Initial Problem List

Initial Assessment & Plan A) invasive ductal ca, Lt P) breast conserving surgery prn) axillary LN dissection

Breast conserving surgery Sentinel node dissection : ca (+) → axillary LN dissection (level II) Nipple resection margin : ca(-) hyperplasia(+) → 5mm 가량 더 절제 Pathology: Invasive ductal carcinoma Lymph node: reactive change (16/16) Excision margin, Lt: Intraductal carcinoma with microcalcification (06/12/8)

Pathology

Chest CT ( )

Modified Radical Mastectomy OP note: 이전 axillary LN dissection 한 곳 까지 resection → Stage IIb (T1N1M0) +1/17 P> adjuvant chemotherapy (06/12/15)

F/49, LUO 1.5cm breast mass Mammography, breast sono core biopsy suspicious malignancy Invasive ductal ca BCS c axillary dissection

Stage IIb T1N1M0 refer to hemato-oncology for adjuvant chemotherapy MRM, Lt BCS c axillary dissection Margin (+)

F/49 s/p MRM, Lt (stage IIb T1N1M0) Premenopausal ER(+) PR(-) Her-2 (+++) AC + Tamoxifen

AC #4 (06.1.4~06.3.8) Adriamycin 90mg Cyclophosphamide 900mg Tamoxifen ( ~ ) Tamoxifen 100mg bid

Abdomen CT ( )

Liver biopsy ( )

Pathology

T-L spine MRI ( )

F/49 s/p MRM, Lt (stage IIb T1N1M0) Premenopausal ER(+) PR(-) Her-2 (+++) AC + Tamoxifen TxH hepatic, spinal metstasis

TxH ( ~ ) Trastzumab 200mg iv loading Paclitaxel 250mg iv Trastzumab 100mg iv weekly #13

Liver CT ( )

F/49 s/p MRM, Lt (stage IIb T1N1M0) Premenopausal ER(+) PR(-) Her-2 (+++) AC + Tamoxifen TxH hepatic, spinal metstasis GV hepatic metstasis aggravation

GV ( ~ ) Gemzar 1400mg iv Vinorebine 35mg iv

Clinical Course AC TxH GV