A solitary brain metastasis as the only site of recurrence of HR positive, HER2 negative breast cancer: a case report and review of the literature

Sandipkumar H Patel,Bhuvaneswari Ramaswamy,Andrew Stiff,Mahmoud Kassem,Robert Wesolowski,Yoshihito David Saito,Zaibo Li

doi:10.1186/s13256-020-02615-2

Abstract

BackgroundBreast cancer is one of the most common causes of brain metastases. However, the presence of isolated central nervous system (CNS) metastatic disease early in the course of disease relapse is a rare event in cases of hormone receptor positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer.Case presentationWe summarize the clinical course of a pre-menopausal, 39-year old Caucasian female with history of operable, hormone receptor positive, HER2 negative breast cancer who was initially treated with curative-intend therapy but who unfortunately developed solitary metastatic lesion in the left thalamus. A biopsy of the lesion confirmed the presence of hormone receptor positive, HER2 negative metastatic breast cancer. Patient’s CNS metastases continued to progress without any evidence of metastatic disease outside of the central nervous system and she eventually passed away about 5 years after the date of her initial diagnosis and 18 months following the diagnosis with brain metastasis.ConclusionBased on our case, although rare, patients with treated, operable, hormone receptor positive, HER2 negative breast cancer can present with solitary brain metastasis as the only sign of disease recurrence.

Highlights

Brain metastases from breast cancer occur in 15–25% of patients, representing the second most common cancer to metastasize to the brain, after lung cancer [1]
Based on our case, rare, patients with treated, operable, hormone receptor positive, human epidermal growth factor receptor 2 (HER2) negative breast cancer can present with solitary brain metastasis as the only sign of disease recurrence
This report describes a unique case of a pre-menopausal patient with operable, hormone receptor (HR) positive, HER2 negative breast cancer who developed central nervous system (CNS) only recurrence of her disease

Summary

Conclusion

This report describes a unique case of a pre-menopausal patient with operable, HR positive, HER2 negative breast cancer who developed CNS only recurrence of her disease. Despite eventual disease progression within the CNS, she has never developed extra-cranial metastatic disease. This emphasizes the need for clinical suspicion in patients with treated, operable hormone receptor positive, HER2 negative breast cancer who present with neurological symptoms. This case report suggests that patients with CNS only metastatic disease have the potential to experience long survival if their CNS disease is treated with aggressive local and systemic therapy.

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