ABSTRACT
De ne-se carcinoma de mama bilateral sincroÌnico (CMBS) pelo diagnoÌstico de dois tumores primaÌrios simultaÌneos. Relata-se o caso de uma paciente do sexo feminino, 55 anos, caucasiana, que procurou o mastologista por uma lesaÌo na mama direita (MD). Ao exame fiÌsico na MD, notou-se um abaulamento no quadrante superior externo (QSE), retraçaÌo e ulceraçaÌo de pele e palpou-se massa de 5 cm no QSE, endurecida, irregular, com expressaÌo mamilar negativa e linfonodo axilar suspeito e com estaÌdio cliÌnico III (T4b N1 Mx). A mama esquerda (ME) apre- sentou-se normal. A mamogra a mostrou noÌdulo suspeito no QSE da MD (BI-RADS V) e ME com calci caçoÌes monomoÌr cas (BI-RADS II). A ressonaÌncia magneÌtica revelou noÌdulo soÌlido, heterogeÌneo (3 cm) no QSE da MD (BI-RADS V) e tambeÌm noÌdulo soÌlido, irregular (7 mm) no quadrante inferior externo (QIE) da ME (BI-RADS V). Os demais exames naÌo demonstraram metaÌstases. A bioÌpsia revelou carcinoma ductal invasivo (CDI) na MD e carcinoma ductal in situ na ME, compatiÌvel com CMBS. Na ME, a imuno-histoquiÌmica demonstrou receptores de estrogeÌnio e progesterona positivos, CERB-B2 negativos e Ki-67 com expressaÌo nuclear positiva em 5% das ceÌlulas neoplaÌsicas. Na MD, receptores triplo-negativos e Ki-67 positivo em 10%. ApoÌs quimioterapia neoadjuvante, a paciente foi submetida a mastectomia direita com linfade- nectomia axilar e quadrantectomia esquerda com linfonodo sentinela. O anatomopatoloÌgico da MD evidenciou carcinoma ductal invasor residual, margens ciruÌrgicas e linfonodos livres. Na ME, linfonodo sentinela livre e resposta patoloÌgica completa. Prosseguiu-se o tratamento com radioterapia e Tamoxifeno. Atualmente, a literatura meÌdica sobre o CMBS eÌ escassa, di cul- tando o manejo terapeÌutico nos casos em que cada tumor exibe caracteriÌsticas bioloÌgicas diferentes.
Bilateral synchronous breast carcinoma (BSBC) is de ned by the simultaneous presence of two prima- ry tumors at diagnosis. is is a case report of a female patient, aged 55 years, Caucasian, who sought a mastology service because of a lesion in the right breast (RB). In physical examination, a lump in the RB was noticed in the superolateral quadrant (SLQ), as well as retraction and skin ulceration, with a palpable irregular mass of 5 cm, without nipple discharge, abnormal axillary lymph node, and stage III (T4b N1 Mx). Left breast (LB) was normal. Mammography showed suspicious lump in SLQ of RB (BI-RADS V), LB with monomorphic calci cations (BI-RADS II). MRI revealed a solid heteroge- neous nodule (3 cm) in SLQ of RB (BI-RADS V) and an irregular solid nodule (7 mm) in inferolateral quadrant (ILQ) of LB (BI-RADS V). Metastasis was not found on other tests. Biopsy revealed invasive ductal carcinoma in RB and ductal carcinoma in situ in LB, compatible with BSBC. On LB, the immu- nohistochemistry showed positive estrogen and progesterone receptors, negative for CERB-B2 and Ki-67 positive nuclear expression in 5% of tumor cells. RB presented triple-negative receptors and Ki-67 posi- tive in 10%. After neoadjuvant chemotherapy, a right mastectomy with axillary lymphadenectomy and left quadrantectomy with sentinel lymph node was performed. Anatomopathological exam of RB showed residual ductal carcinoma, free surgical margins and lymph nodes. In LB, sentinel lymph node was disease free and there was a complete pathological response. Treatment was continued with radiotherapy and Tamoxifen. Currently, the medical literature on the BSBC is scarce, thus hampering the therapeutic management in cases where each tumor displays di erent biological characteristics.
