Case report - A 37 year old Para 0+1 woman from the former Yugoslavia booked at 8 weeks. She discovered a breast lump at 13 weeks, consulted her GP at 16 weeks. Diagnosis of breast cancer was made 2 weeks later. At mastectomy at 20 weeks a high grade HER-2 positive tumour was found. 9 of 13 lymph nodes were positive. Work up including CXR, Liver USS revealed no sign of metastasis. Chemotherapy was planned for 25 weeks. The patient came in breathless at 24+5weeks. V/Q scan showed a high probability for pulmonary embolus. She was admitted for ongoing dyspnoea and chest pain, but oxygen saturations deteriorated despite enoxaparin treatment. CT showed no PE, but a massively enlarged liver. MDT review gave differential diagnosis of; carcinomatosis, possibly HELLP or haemophagocytic lymphohistiocytosis. Caesarean section was performed for maternal compromise at 26+0 weeks. A live female infant weighing 800g was delivered in good condition and transferred to a tertiary neonatal unit. She had intact survival at one year of follow-up. However the patient was transferred to a tertiary unit where she sadly died 10 days later. Post-mortem showed micrometastatic breast cancer in the liver and lungs.
Discussion - The rapid progress of the cancer was astonishing. From discovery of the lump to maternal demise was about 3 months. One consideration is that radiation exposure from the NATO bombings of Serbia in the mid 1990s using depleted uranium may have caused this particularly aggressive breast cancer.