Problems with the Use of Breast Conservation Therapy for Breast Cancer in a Patient with Neurofibromatosis Type 1: A Case Report

Abstract

Patients with neurofibromatosis type I and breast cancer represent a subset of people who may be considered at high risk for secondary cancers after conventional whole breast radiation therapy and breast conservation surgery. A case of a 49-year-old woman with neurofibromatosis type I is presented. She was diagnosed with a 1.1-cm right breast infiltrating ductal carcinoma. Clinical, diagnostic imaging, and pathologic features are discussed. Her initial treatment plan of breast conserving therapy was thwarted when her sentinel node biopsy was positive for micrometastatic disease in 1/14 lymph nodes. She elected to have a bilateral simple mastectomy. This case addresses the rare dilemma of offering breast conservation therapy as a viable option for patients with neurofibromatosis type I. Current data on radiation-induced secondary cancers such as sarcoma after treatment for breast and other cancers are reviewed.

Breast cancer and neurofibromatosis type 1: a diagnostic challenge in patients with a high number of neurofibromas

“…Physical examination of this patient was also somewhat impaired because of the amount of cutaneous lesions. The difficultly in detecting breast cancer in NF1 individuals with numerous skin neurofibromas has been reported previously [ 4 , 9 , 10 ]. NF1 can obscure or delay the identification of breast lesions not only because skin neurofibromas can mask the signs of a malignant lesion, but also because patients and physicians may mistakenly consider a breast mass to be a manifestation of the primary disease [ 11 ].…”

Breast neurofibroma: A case report

“…The NF1 gene is located on chromosome 17 in the 17q11.2 region and encodes neurofibromin, a protein involved in the control of cell proliferation and differentiation that inhibits the p21 ras activation pathway [1] . Its incidence is approximately one in 3000 to 4000 births without gender predominance [6] . NF1 is a progressive multisystem disease that mainly affects the skin, eyes, central and peripheral nervous system, skeleton and vessels.…”

Surgical dilemma of the management of breast cancer in a patient with neurofibromatosis: case report and a review of the literature

“…Hasson et al . presented a case where breast conservative treatment was initially considered but was later thwarted and a mastectomy was performed [ 9 ]. Similarly, Salemis and Nakos reported a case of a delayed presentation of breast cancer in a patient with NF-1 as patient thought her mass was a manifestation of her known NF-1 disease.…”