A Woman With Worsening Abdominal Pain and Nausea

Avan Armaghani, MD


September 08, 2023

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A 68-year-old woman presents to a local emergency department with progressively worsening abdominal pain of 5 days' duration. She reports decreased appetite and nausea without vomiting. She has no fever or chills, shortness of breath, cough, or diarrhea. Antacid medications have failed to relieve her symptoms.

Eleven years earlier, the patient received a diagnosis of cancer of the right breast that was estrogen receptor positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor 2 negative (HER2-). She underwent neoadjuvant chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel, followed by a partial mastectomy of the right breast. Final pathology revealed grade 3 invasive lobular carcinoma that measured 3.5 × 3.2 × 1.8 cm. One sentinel lymph node was positive for metastatic carcinoma. The final pathologic staging was ypT2N1(sn). She received adjuvant radiation therapy and completed 5 years of adjuvant aromatase inhibitor therapy. She has remained on active surveillance.

Her family history is negative for a history of cancer. The patient had genetic testing performed at the time she was initially diagnosed with breast cancer, and it showed a pathogenic PALB2 mutation.


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