Fertility Preservation in a Premenopausal Breast Cancer Patient

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Contrast-enhanced MRI

Fertility preserving surgery in a 34-year-old patient with invasive ductal carcinoma.

A 34-year-old nulliparous woman, gravida 0, para 0, presented to the outpatient department with complaints of a lump in her right breast.

Examination:

On examination, a 2-cm lump was palpated in the upper quadrant of her right breast without palpable axial lymphadenopathy.

Imaging:

  • Diagnostic mammography was performed, which detected a mass without speculation.
  • Ultrasound breast was performed, which revealed a 22-mm hypoechoic solid mass.
  • Contrast-enhanced magnetic resonance imaging (MRI) showed a 21-mm mass in the right breast with rim enhancement at the 12 o’clock position.
  • Computed tomography of the thorax and abdomen confirmed the absence of distant organ metastases and no significant lymphadenopathy, including in the axilla.

Histopathological evaluation of the right breast’s mass confirmed that it was a Grade 3 invasive ductal carcinoma. Immunohistochemistry was performed, which confirmed HER2 1+, negative ER, and negative PR.

A biopsy sample was obtained from the right axillary lymph node, the results of which confirmed the absence of breast cancer metastasis (i.e., Stage IIA [T2N0M0]).

While presenting the management options to the patient, she expressed her wish to preserve fertility. Therefore, in vitro fertilization (IVF) was planned before initiating neoadjuvant chemotherapy.

In-vitro Fertilization:

Ovarian stimulation was performed using letrozole and human menopausal gonadotrophin, followed by retrieval of 10 oocytes twenty-six days after the initial visit. With the retrieved oocyte, IVF was performed. Six good quality embryos were cryopreserved following embryo transfer.

Neoadjuvant chemotherapy was initiated 11 days later and she underwent four cycles of chemotherapy with 5-FU, epirubicin, and cyclophosphamide (FEC), followed by 4 cycles of docetaxel every 3 weeks.

After neoadjuvant chemotherapy, signs of breast cancer had disappeared. Chemotherapy was followed by breast-conserving surgery and sentinel lymph node biopsy. Radiotherapy was provided after breast-conserving surgery, but no systemic therapy was provided.

Ten months after the breast surgery, when the treatment cycles had been completed, the frozen embryo transfer was performed, and periodical menstruation was recovered.

Successful pregnancy:

The patient got pregnant with only one transfer in hormone replacement cycles. She delivered successfully at 40 weeks of gestation.

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