Multiple metastases of human epidermal growth factor receptor 2‑positive, hormone receptor‑positive, pT1a pN0 breast cancer within 1 year after surgery: A case report

Suzuki,Takafumi; Einama,Takahiro; Takushima,Miki; Araki,Yakumo; Wakamatsu,Katsuyuki; Kobayashi,Kazuki; Ohno,Hiroki; Fukumura‑koga,Makiko; Yamasaki,Tamio; Ueno,Hideki; Tsuda,Hitoshi; Kishi,Yoji

doi:10.3892/ol.2024.14498

Multiple metastases of human epidermal growth factor receptor 2‑positive, hormone receptor‑positive, pT1a pN0 breast cancer within 1 year after surgery: A case report

Authors:
- Takafumi Suzuki
- Takahiro Einama
- Miki Takushima
- Yakumo Araki
- Katsuyuki Wakamatsu
- Kazuki Kobayashi
- Hiroki Ohno
- Makiko Fukumura‑koga
- Tamio Yamasaki
- Hideki Ueno
- Hitoshi Tsuda
- Yoji Kishi
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Affiliations: Department of Surgery, National Defense Medical College, Tokorozawa, Saitama 359‑8513, Japan, Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama 359‑8513, Japan
Published online on: June 12, 2024 https://doi.org/10.3892/ol.2024.14498
Article Number: 365
Copyright: © Suzuki et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Adjuvant chemotherapy is usually not considered for pT1a pN0 human epidermal growth factor receptor 2 (HER2)‑positive breast cancer due to its low recurrence rate. The present report describes a case of pT1a hormone receptor‑positive HER2‑positive breast cancer with multiple recurrences in the axillary lymph nodes and liver within 1 year after radical surgery. A 58‑year‑old woman underwent left total mastectomy and sentinel lymph node biopsy for left breast cancer with pathological stage IA (pT1a pN0). The subtype corresponded to luminal B‑like breast cancer with a nuclear grade of 3 and a Ki‑67 labeling index of 37%. An aromatase inhibitor (letrozole) was planned to be administered for 5 years after surgery, but the patient was diagnosed with multiple liver and axillary lymph node metastases 11 months after surgery. After 1 year of chemotherapy (paclitaxel) in combination with anti‑HER2 therapy (pertuzumab and trastuzumab), liver metastases resolved. A complete response of the liver lesion has been maintained 4 years after the anti‑HER2 therapy initiation. The present case exhibited two poor prognostic factors: High Ki‑67 labeling index and nuclear grade 3. Based on the ‘Predict’ tool, the present case would be expected to have a cancer‑related mortality rate of 6% 10 years after surgery with adjuvant endocrine therapy. Although this value may be controversial for postoperative anti‑HER2 therapy, the present case should not be considered to be a low‑risk case. When the identification of high‑risk pT1a pN0 HER2‑positive breast cancer is possible, postoperative anti‑HER2 therapy plus chemotherapy would be effective in decreasing the rate of recurrence.

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