Abstract
Thyroid and breast cancer are the most common cancers among young women, which are either synchronous or metachronous, but the association is yet to be elucidated. With the improvement of diagnosis and treatment, there is an increase in breast and thyroid cancer survivors. Hence, attention is shifting towards survivorship. Here, we report the case of a young lady diagnosed with synchronous thyroid and breast cancer who unexpectedly became pregnant during tamoxifen treatment. After a multidisciplinary discussion, endocrine therapy was interrupted and she delivered a healthy baby at term. In conclusion, oncologists should be aware of breast and thyroid cancer co-occurrence and examinations should be conducted together in diagnosis and follow-up. Also, pregnancy is feasible and can be considered after synchronous breast and thyroid cancer diagnosis. Physicians need to emphasise the use of barrier contraceptives to patients undergoing endocrine therapy. However, the optimum timing for pregnancy after breast cancer and the safety of endocrine therapy interruption in hormonal-positive patients should be discussed and managed by a multidisciplinary team.
Highlights
While breast cancer (BC) is the most common malignancy in women worldwide, thyroid cancer (TC) is the most prevalent endocrine cancer
Synchronous BC–TC is rare compared to metachronous tumours, they share some clinical–pathological similarities
We have reported the first case of pregnancy after synchronous BC–TC
Summary
While breast cancer (BC) is the most common malignancy in women worldwide, thyroid cancer (TC) is the most prevalent endocrine cancer. The neck ultrasound showed a moderately enlarged right thyroid lobe with a heterogeneous solid and cystic mass of 3.8 cm × 2.0 cm with reactive bilateral level II cervical lymph nodes. Focal vascular and extracapsular invasions were present (Figure 2) She started levothyroxine 100 mcg and adjuvant chemotherapy (5-FU, adriamycin, cyclophosphamide) FAC six cycles. The patient decided not to breastfeed and resumed tamoxifen in August 2017 She was well until April 2020, when she developed a resectable chest wall recurrence. Figure. (A): Low power view of the breast infiltrating ductal carcinoma; NOS showing cords of large malignant cells (arrow) separated by scant stroma; no papillae are detected (H&E × 100). (B): Higher power view of the breast carcinoma; the malignant cells are large with vesicular pleomorphic nuclei, coarse chromatin, with no classic nuclear features of papillary carcinoma; (arrow) the cytoplasm is ample and eosinophilic (H&E × 400)
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