Breast cancer in a patient with Birt-Hogg-Dubé syndrome (BHDS) with dramatic response to neoadjuvant chemotherapy

Abstract

This is a case of 49-year-old white woman who presented with a rapidly growing right sided breast mass. A subsequent punch biopsy confirmed grade 3 invasive mammary carcinoma of no special type which was negative for oestrogen receptor, progesterone receptor and Her-2 neu overexpression. She was a carrier of folliculin gene mutation that is characteristic of Birt-Hogg-Dubé syndrome (BHDS), a condition known to cause skin lesions, renal cancers and pneumothoraces. Family history revealed patient's mother, grandmother and maternal aunt developed renal cell carcinomas during their lifetime and were positive for the same germ line mutation. Tumour tissue was positive for TP53 mutation and negative for BRCA1, BRCA2 and other genes commonly associated with breast cancer. We report a patient with BHDS presenting with breast cancer that showed dramatic response to neoadjuvant chemotherapy prior to bilateral mastectomy, local chest wall radiation and 6 months of adjuvant capecitabine.

Keywords: breast cancer; cancer - see oncology; cancer intervention; carcinogenesis; radiotherapy.

Figure 1

Histopathology-right breast mass, punch biopsy. Invasive mammary carcinoma of no special type (ductal, not otherwise specified), grade 3.

Figure 2

(A) Fungating mass at presentation; (B) 2 weeks after initiating dose dense AC; (C) 4 weeks after initiating dose dense AC; (D–H) respective photographs of the mass progressively resolving after second, third, fourth, fifth, sixth months with neoadjuvant chemotherapy, eventually reducing to a scar. Patient underwent bilateral mastectomy with breast reconstruction, thereafter.