CASE REPORT
A 57-year-old female, who was found to have invasive ductal carcinoma from another hospital months prior, presented with palpable hard lumps on the right side of the breast. She visited our outpatient clinic without any underlying systemic disease or significant physical findings. Her clinical manifestations revealed a hard nodule over the right breast, 11/3, 3 cm in size with skin invasion. No nipple retraction or discharge and no palpable lymph nodes were noted.
On admission, laboratory findings, including biochemistry data and cardiac enzyme levels, were unremarkable. Image studies such as chest X-ray and chest computed tomography (CT) scan were planned to examine further manifestations. Chest X-ray showed no obvious abnormality, while CT scan of the chest revealed a 2.5-cm soft-tissue mass in the UOQ of the right breast with skin invasion, a 1.3-cm ground-glass nodule in the left lower lung, and an 11-cm large soft-tissue mass in the left upper quadrant of the abdomen [Fig 1A]. Furthermore, CT scan of the abdomen revealed a huge multilocular cystic lesion (size, about 29.3×17.2×19.4 cm) possibly arising from the left adnexal region, where mucinous cystic neoplasm of the ovary was highly suspected [Fig 1B]. After the surgery, the diagnosis was respectively confirmed based on the surgical and pathological findings on December 24, 2020: Breast: Invasive ductal carcinomas, grade II, pT2N0M0, stage II status post modified radical mastectomy on the right side. Ovary: Mucinous cystadenoma of the right side ovary, status post exploratory laparotomy with right salpingo-oophorectomy, removal of the residual cervix, appendectomy, and peritoneal washing cytology. Lung: Adenocarcinoma of the lung, moderately differentiated, left lower lobe, pT1a0M0, stage IA status post uniportal non-intubated video-assisted thoracic surgery with wedge resection of the left lobe of the lung and mediastinal lymph node dissection.
The patient underwent a combined surgery: right side modified radical mastectomy, uniportal video-assisted thoracoscopic surgery, and exploratory laparotomy with right salpingo-oophorectomy. Triple primary tumors in the breast, lung, and ovary (Fig 2) were removed. Pathological findings showed invasive ductal carcinomas, grade II, with focal micro-papillary and lobular features in the breast, while adenocarcinoma, moderately differentiated, was noted in pathology findings. Finally, the huge cyst was pathologically noted as a mucinous cystadenoma with focal borderline change. The postoperative hospitalization was uneventful, and the patient was discharged after 1 week.