This is the case of a 27-year-old female who underwent breast lumpectomy for fibroadenoma of the left breast. Pathologic evaluation of the specimen revealed lobular carcinoma in situ (LCIS) entirely confined to a large fibroadenoma without LCIS in the surrounding breast tissue.

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This case reviews synchronous bilateral breast cancer with left infiltrating ductal carcinoma ER+/PR−, Her2− and right invasive lobular carcinoma ER+/PR−, Her2−. Independent primary bilateral breast tumors are present in 0.2–3.2% of breast cancer. Biopsy also showed differing ER status on the left breast versus the node which was triple negative. The final sentinel node was a left internal mammary node. Recent studies have found that the ER, PR and HER2 status of the primary tumor do not always correlate to the ER, PR and HER2 status of the metastatic sites. This can have deleterious effects on survival. There are no clear guidelines on course of treatment for these complex cases. A review of the current literature is supportive of treating the highest-risk breast malignancy. Despite the unusual pathology and severity of disease, our patient is doing well with treatment.