Discordance Of Hormone Receptor And HER-2 Expression Between Primary And Synchronous Metastatic Lesions Of Breast Cancer

Breast cancer is currently treated by individualized therapy based on molecular phenotypes of tumor tissue.However,a proportion of patients can have local or distant metastasis at the initial diagnosis from clinical observation.For these patients,the clinical treatments are usually depend on the pathological characteristics of the primary tumor.However,this treatment mode often ignores the possibility of phenotypic discordance between the metastatic and primary lesions,and thereby lead to poor response to therapeutic regimens and delay in treatment timing.Herein,this paper intends to report the diagnosis and treatment of a locally advanced breast cancer patient at her first diagnosis.We found that the receptor statuses between primary lesion(Luminal B,HER-2+)and metastatic lesion(triple-negative)in right subclavian lymph node are entirely different in the process of the treatment.The strategies based on the molecular phenotype of the primary lesion did not bring significant benefits to the patient,but the treatment depended on the metastatic lesion once controlled the disease well,and the progression-free survival time was up to 7 months.Inevitably,the patient eventually encountered disease progression by showing metastasizing to lung(triple-negative).Currently,the patient is still in palliative treatment,and the overall treatment evolution of her disease showed clinical features in consistent with thebiological characteristics of triple negative breast cancer.Through the analysis and summary of this case,combining with literature review,this thesis aims to discuss the possible mechanism of molecular phenotypic discordance between the metastatic and primary lesions of breast cancer,as well as to elucidate the influences of identifying this discordance on the clinical treatment decisions and patient prognosis,which may shed new light on the understanding of molecular biological characteristics of breast cancer and provide information and reference for real-time accurate diagnosis and treatment of breast cancer.