7.6 Case Analysis
（1）Current medical history：
The female patient，aged 45，was admitted to the hospital in 2019-05-07 due to“diagnosed right breast cancer in January，discovered liver metastasis for 2 days”.The patient inadvertently became swollen in April 2017，about the size of“egg”，no tactile pain，no nipple spill，indicating that the skin is free of redness，break，wrinkled，no cough，chest tightness，palpitations，etc.2017-4-13 Mammography：1.Substantive position in the right breast，about 45×37×21mm，skin（+）BI-RADS：class 4C；2.Abnormal substantive echo of the right armpit，about 30×21mm（like fusion），consider metastatic lymph node swelling.Operated“Right breast lump puncture biopsy”，pathological return：right breast mass impregnation catheter cancer，grade Ⅱ，immune grouping：ER（about 3%），PR（about 10%），Her-2（3+），KI-67（30%）.The patient refused treatment and asked to be discharged because she was 36 weeks pregnant.2017-5-11 Patients return to hospital，operated breast and abdominal MR，CT：1.Right breast lower quadrant leaf-like lump，size about 4.2cm×2.2cm×2.8cm，consider breast cancer（BI-RADS：5）；2.Multiple nodules in the liver，the largest of which is about 2.1cm×1.9cm，in line with the performance of MRI of hepatic metastasis.Biopsy of liver puncture：adenocarcinoma，immunohistized ER（-），PR（-），Her-2（3+），KI-67（40%），consistent with breast cancer liver metastasis.
（2）Physical examination
General situation and psychiatry，skin sclorma without yellowing.Double breasts symmetry，no redness and break，skin adhesion（+），the lower quadrant of the right breast 3 o'clock，touching a lump of about 5 cm x 4 cm x 3 cm size，hard，border clear，poor activity，right armpits and about 3 cm x 3 cm size swollen lymph nodes；Double lungs hearing breathing sound clear，heart rhythm，abdominal pain-free.
（3）Past history：Physical fitness.
（4）Lab inspection：No abnormalities in liver and kidney function and blood routine.
（5）Impact examination 2017-5-11 abdominal MR，CT show：multiple nodules in the liver，the largest of which is about 2.1cm x 1.9cm，in line with the performance of MRI of hepatic metastasis.Cranial MR，chest CT，bone scan（-）.
（6）Pathology examination：Right breast mass absorbent catheter cancer，grade Ⅱ，immunohistization：ER（about 3%），PR（about 10%），Her-2（3+），KI-67（30%）.Liver adenocarcinoma，immunohistized ER（-），PR（-），Her-2（3+），KI-67（40%），consistent with breast cancer liver metastasis.
（7）Diagnosis：Right breast-immersed catheter cancer stage Ⅳ
Liver transfer
Right armpit lymph node metastasis
Image
Pathology
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Clinical Decision-Making and Analysis
（1）Indication：HER2-positive breast cancer patients with rapid progress，important organ metastasis，should be the combination of systemic chemotherapy targeted treatment.
（2）Status assessment：middle-aged women in patients，the general situation can be，liver and kidney function and blood routine did not see abnormalities.
（3）Treatment options：HER2-positive metastatic breast cancer，the preferred treatment should be the treatment based on the thorades monoantigen.Studies have shown that qutobeu-bead resistance is better combined with chemotherapy drugs.It is proposed to give the treatment of quto beads mono-anti-caplating and yew alcohol.
（4）Note：That combination of quto-bean resistance and chemotherapy drugs may increase heart muscle damage，and heart failure may occur in severe cases.The past history，physical examination，electrocardiogram，echocardiogram LVEF baseline assessment should be used after the application of quto bead monoantigen，the period of use should be monitored every three months heart function.
Treatment process
（1）Treatment procedure：Sequoia monoantigen and cacressaq3w were used on November 2，2017 to maintain chemotherapy during the 6-cycle rescue chemotherapy period from May 11，2017 to October 13，2017.
（2）Effect assessment and adverse reaction treatment：2，4，6 cycles after the disease assessment：PR，maintenance of chemotherapy 8 cycles after the disease assessment：CR.Adverse reactions：digestive tract reaction 0 to 1 degree.
Prognosis Assessment
Although the patient appeared liver metastasis，through chemotherapy combined with cantiphre monoantigen treatment，managed to reach PR，the treatment effect is good longer survival arailable.
Post-treatment imaging
Experience：Breast cancer metastasis re-biopsy to clarify the pathology，especially the clear molecular typed is necessary.Anti-HER-2 treatment plays an important role in HER2-positive metastatic breast cancer treatment，while anti-HER-2 treatment is also very important in HER2-positive breast cancer complementary treatment.CR may transfer into an extension of OS after combination chemotherapy for advanced metastatic breast cancer.
Summarize：For HER2-positive breast cancer，chemotherapy combined with cantiphlymono resistance in some patients is desirable to have a very good effect.Chemotherapy and targeted therapy after combination can extend disease control.
（Zhen Li，Tianning Zou）