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.