5.1.3 Case Study
Name：Yang××Gender：Female Age：49 years Ethnicity：Han Nationality Marriage：Married
Chief complaint：I found the left breast mass for more than 2 months.
Current medical history：In March 2019，the patient inadvertently found the upper left quadrant of the left breast has large mass about the size of the“broad bean”，hard，unclear border，fixed，local skin without redness，rash，no fever，fatigue and other discomfort.In May 2019，after going to the outpatient clinic of our hospital，I was admitted to the hospital and improved the relevant examinations without surgical contraindications.On May 30，2019，the local anesthesia was performed on the left breast mass in minimally invasive surgery.The postoperative pathological report diagnosis：left breast infiltration cancer，immunohistochemistry（X2019-07534）ER（-）PR（weak+，20%）HER2（-）KI67（40%），invasive ductal carcinoma.
Past history：Denial of hepatitis，tuberculosis，history of infectious diseases，history of cardiovascular disease，ovarian cysts，uterine fibroids resection in 2018，denial of history of trauma，denial of blood transfusion history，sulfonamide allergy，vaccination history unknown.
Personal history：Born in the original place，he lived in Qujing City，Yunnan Province for a long time，no epidemic area，epidemic situation，contact history of infected water，no smoking，drinking history.
Marriage and Childbirth：Married at the age of 20，the spouse's physical condition：alive，2 children.Pregnancy 2，births 2，fetuses 2.
Menstrual history：menarche 17 years old，4-7/28，last menstrual 2019-5-22.Menstrual cycle rules，medium menstrual volume，normal color.No blood clots，no pain.
Family history：parents are alive，brothers and sisters are alive，denying family history of infectious diseases，hereditary history，and history of cancer.Physical examination
Body temperature：36.0C Pulse：80 beats/min Breath：18 beats/min Blood pressure：120/80mmHg.
Height：170cm Weight：60kg Body surface area：1.6924m2 KPS score：100 points.
Specialist examination
The breasts are symmetrical and the appearance of the skin is normal.The upper outer quadrant of the left breast can reach a mass of about 2.5cm×2.5cm×1cm，which is slightly softer and smaller than before.It is hard，the boundary is unclear，the activity is poor，and the skin is stuck（-），no redness and ulceration，the right breast is not clear and abnormal，bilateral lymph nodes and supraclavicular lymph nodes.
Auxiliary inspection
Ultrasound of the breast：The outer left quadrant is about 31×15mm in the direction of 2 to 3∶30.The shape is irregular，the boundary is not uniform，the convex and concave are uneven，the boundary is unclear，and it is jagged.The Color Doppler shows：the periphery of the mass and a rich blood flow signal can be seen inside.The left axilla can be seen with 2-3 abnormal parenchymal echoes，ranging insize from about 14×7 mm.The shape is elliptical and the boundary is clear.Color Doppler shows that a few point-like blood flow signals can be seen in the abnormal parenchymal echo.(https://www.daowen.com)
Substantial mass lesions in the left breast，the nature of which is to be investigated，BI-RADS：4C，considering the possibility of breast Ca.
The left axilla often has a different parenchymal echo，and the nature is to be investigated，considering lymphadenopathy.
Right breast：no obvious abnormalities.
Mammography：The outer upper quadrant of the left breast sees an irregular mass，about 1.9cm×2.1cm×2.2cm，the edge is blurred，the density is increased and uneven，and there are a lot of nematode-like and rough heterogeneous calcification in the inner and front edges.The local distribution is segmental，with a range of about 4.1 cm×1.3 cm.The surrounding gland structure is disordered，and the density of the adjacent subcutaneous fat layer is increased.There is no obvious block shadow and malignant calcification in the right breast，the subcutaneous fat layer is clear，and the skin is not thick.The nipple is normal.
1.Left external breast quadrant space-occupying lesion with calcification，malignant nature，consider breast cancer，please combine MRI to determine the extent of the lesion.BI-RADS：5
2.Double breast hyperplasia，it is recommended to review regularly.BI-RADS：1
Mammary gland MR：The upper left quadrant of the left breast is irregular and the T1 slightly longer T2 signal mass，the edge is blurred，and the size is about 2.8cm×1.8cm×2.0cm.The bilateral breast gland signals were uneven，and after enhancement，there were multiple spots and small nodular enhancements.There were no abnormalities in the bilateral nipple，areola，posterior interstitial space，skin and subcutaneous fat layer.No exact enlarged lymph nodes were seen under the eyes in the scan range.
1.Left upper breast upper quadrant mass and central zone abnormal signal foci，considering breast cancer.BI-RADS：5
2.MRI manifestations of double breast hyperplasia.BI-RADS：1
Diagnosis：Left external breast quadrant invasive ductal carcinoma cT2N0M0 IIA，triple negative
Treatment：The patient was diagnosed as cT2N0M0 IIA in the left upper quadrant invasive ductal carcinoma，and the molecular type was triple negative.According to the guidelines，the tumor size was＞2cm，the triple negative type，feasible neoadjuvant chemotherapy，and the chemotherapy regimen chose the anthraquinone ring.And the scheme of the purple shirt class.Neoadjuvant chemotherapy：EC-T（epipirin 90mg/m2，cyclamin 600mg/m2，specifically E-ADM 130mg d1，CTX 0.8g d1）Scheduled 4-cycle EC followed by sequential T（Docetaxel 80-100 mg/m2），21 days one cycle.
Breast ultrasound after 2 cycles of neoadjuvant chemotherapy
The left external quadrant can be seen at about 18×15×13 mm from 2 to 3∶30.Color Doppler shows that there are abundant blood flow signals around and inside the tumor.The left axilla can be seen with 2-3 abnormal parenchymal echoes of different sizes，most of which are about 17×6 mm.The shape is elliptical and the boundary is clear.Color Doppler shows that there are a few punctate blood flow signals in the abnormal parenchyma.
After 2 cycles of neoadjuvant chemotherapy，the therapeutic effect was evaluated as partial remission（PR）.