when deciding how to treat colorectal tumours and has important implications for personalized cancer therapy. were not measured at any AZD6244 Selumetinib time. During chemotherapy the patient underwent ultrasound examinations on a weekly basis. Three weeks after the start of chemotherapy, the ultrasound showed anhydramnios of the fetus. A further ultrasound found that the growth of the fetus was consistent with the normal curves for its 33th week of gestation. No signs of organ malformation were found, particularly with regard to the kidneys. The fetal Doppler showed normal values and there were no signs of anemia. Premature or artificial rupture of the membranes was excluded. Because of the anhydramnios, for safety, a cesarean section was carried out three days later at 33 5 weeks, gestation.
The patient delivered a girl with Apgar scores of 8/9/9 and a birth weight of 1990 g, the pH of the uterine artery was 7.43. The girl was in good health, with no signs of malformation, abnormalities or disease. Lactation was suppressed and the infant did not receive any breast milk. Unfortunately, due to a communication problem the placenta was not sent for histopathological examination. Examination of the infant directly after the delivery by the pediatricians showed no signs of anemia, malformation or dysfunction of any organ. Follow up examinations of the girl showed revealed no problems. The response to chemotherapy was evaluated and the patient,s tumor showed a regression from 9 cm to 6 cm. In addition, CA 15 3 tumor marker serum levels dropped from 288 U/mL to 109 U/mL.
Based on these positive responses, treatment was continued. After further tumor regression, surgery was carried out. The patient underwent a mastectomy and the enlarged axillary lymph nodes were removed. Histology demonstrated an invasive ductal sclerosing breast cancer, with three positive lymph nodes with node capsule perforation. The pTNM classification was pT3 pN1 G3 L1 V0 R0. After surgery, the patient was again treated with the same chemotherapy regimen. A CT scan following 18 weekly administrations of vinorelbine, showed a mere 6 mm suspect lesion in the sixth thoracic vertebra, and no correlation with the MRI results observed in the lumbar spine region six months prior. In addition, there were no signs of distant abdominal or thoracic metastases, and CA 15 3 tumor marker serum levels were in the normal range of 14 u/mL after 12 months.
The patient and her child are both well, and at her last follow up visit in November 2010, there was still no evidence of disease recurrence, and staging in December 2010 with PET/CT imaging showed no local recurrence, lymph nodes or distant metastases. Discussion Although breast cancer is the most commonly observed cancer during pregnancy, its occurrence is still rare. Because this case report is, to the best of our knowledge, the first to report a primary diagnosis of metastatic breast cancer in a pregnant patient, such metastatic breast cancers during pregnancy must be even rarer. Accordingly, it follows that treatment with bisphosphonates during pregnancy for metastatic disease has not been described before, but only in conjunction with osteoporosis during pregnancy.1,2 A diagnosis of metastatic breast cancer during pregnancy is an even greater dilemma f