CASE 186: LYNCH SYNDROME OR NOT ? Dr JASMINE THANH XUÂN, Dr HỒ CHÍ TRUNG, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 28yo underwent R hemicolectomy as adenocarcinoma in November 2011 at BD hospital. On 4 April 2013 she came back to BD Hospital to be removed  both 2 ovarian tumors (Krukenberg) for metastase from colon tumor. And after surgery of ovarian tumors for 3 weeks, she detects herself her right breast swollen, hard in palpation but without pain so she returned BD hospital again.

BD hospital ultrasound showed secondary right breast tumors and she was sent to MEDIC to take a mammography.

At Medic, X-Rays detected a breast mass, with high density on RUQ of right breast and were thought to be a BIRADS 4 tumor,

and Medic ultrasound again confirmed 3 hypoechoic nodules of 13-22-8mm at 10h, 11h, 1h, irregular borders, with microcalcifications (BIRADS 4)

and right metastatic axillary nodes,

and some R and L cervical nodes.

MSCT 640 proved a right breast tumor with ROI=25HU and axillary nodes and R pectoralis muscles nodes.

FNAC of right breast tumor was done and microscopic result was adenocarcinoma.

In conclusion, a 28yo female patient which were removed R colon tumor and ovarian tumors due to metastase now has a R breast tumor  BIRADS 4 and R axillary nodes and R and L cervical lymph nodes.

Do you think a case of Lynch syndrome? Is it sure that secondary breast tumors? What to do in the next step ?

Surgery was performed on 24/5. So it was a primary breast tumor, both macroscopic and microscopic findings and not a metastatic tumor of the breast from colon tumor and that may belong to Lynch syndrome. Waiting for genetic test to confirm  the final diagnosis of Lynch syndrome.