Synchronous Bilateral Breast Cancer with Heterogeneous Histology - Invasive Ductal and Lobular Carcinoma - A Case Report

Sep 23, 2026

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Synchronous bilateral breast cancer (SBBC) is rare, accounting for about 2–5% of breast cancer cases, with discordant histology in each breast being even less common. This case report describes a 46-year-old woman with invasive ductal carcinoma in the left breast and invasive lobular carcinoma with LCIS in the right breast, confirmed by imaging and biopsy. Bilateral axillary lymphadenopathy was present. The patient received neoadjuvant chemotherapy, left radical mastectomy with axillary dissection, followed by hormonal therapy and adjuvant radiotherapy; right-breast surgery is pending.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Introduction

Case Presentation

Imaging and Diagnosis

Conclusion

Case Reports in Oncology | Case Rep Oncol 2025;18:1457–1467 | | | --- | --- | | DOI: 10. 1159/000548545
Received: July 11, 2025
Accepted: September 9, 2025
Published online: September 18, 2025 | © 2025 The Author(s) .
Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) | This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission. Case Report Synchronous Bilateral Breast Cancer with Heterogeneous Histology: Invasive Ductal and Lobular Carcinoma – A Case Report Ahmad Al-Bitara Ahmad Bishr Nasraa Lama Alsaouba Mohammad Alaa Aldakaka Maher Saifoa, b a Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic; bDepartment of Oncology, Albairouni University Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic Keywords Synchronous bilateral breast cancer · Invasive ductal carcinoma · Invasive lobular carcinoma · Neoadjuvant chemotherapy · Case report Abstract Introduction: Synchronous bilateral breast cancer (SBBC) is rare, comprising 2–5% of all breast cancer cases. Even more uncommon is the presence of discordant histologies in each breast. This report discusses a case involving invasive ductal carcinoma (IDC) in the left breast and invasive lobular carcinoma (ILC) in the right breast. Case Presentation: A 46-year-old Arab woman presented with a 6-month history of a growing lump in the left breast and a newly noticed nodule in the right breast. Imaging and biopsy confirmed IDC (Grade 2, ER+/PR+/HER2−) in the left breast and ILC with LCIS in the right breast. Bilateral axillary lymphadenopathy was observed. She underwent neoadjuvant chemotherapy (doxorubicin/ cyclophosphamide followed by paclitaxel), followed by a left radical mastectomy with axillary dissection. Hormonal therapy (goserelin and exemestane) and adjuvant radiotherapy were initiated. Right-breast surgery is pending. Conclusion: SBBC with discordant histology necessitates a multidisciplinary, individualized treatment approach. Hormone receptor status, tumor biology, and extent of disease all influence treatment decisions. This rare clinical scenario highlights the need for further research and specific management guidelines. © 2025 The Author(s) . Published by S. KargerAG, Basel Correspondence to: Ahmad Al-Bitar, ahmad.albitar [damascusuniversity.edu.sy](damascusuniversity.edu.sy) Case Reports in Oncology Case Rep Oncol 2025;18:1457–1467 1458 | DOI: 10. 1159/000548545 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) | | --- | --- | Al-Bitar et al.: Synchronous Bilateral Breast Cancer with Heterogeneous Histology Introduction Breast cancer is the most common cancer in women in roughly every country, and about half of these women have no specific risk factors besides sex and age [1] . Furthermore, the primary cancer is adenocarcinoma, which is divided into ductal carcinoma (85%) and lobular carcinoma (15%) [2] . Several studies have compared these two subtypes and discovered that they are clinically and molecularly different [3] . The most important difference is that in invasive lobular carcinoma (ILC), the cells lose their adhesion due to loss of E-cadherin expression [4] . Clinically, this subtype has a worse prognosis and requires surgery in most cases [5], where this cancer benefits from neoadjuvant chemotherapy (NACT) less [6] . With the improvement of diagnostic and early detection techniques, the rate of women diagnosed with synchronous breast cancer has increased by 40%[7] . A bilateral synchronous breast cancer incidence is unique, accounting for 2–5% of all types of breast cancer [8] . However, the most important risk factors for the development of bilateral breast c

FAQs

What makes synchronous bilateral breast cancer with discordant histology rare?

Synchronous bilateral breast cancer occurs in about 2–5% of all breast cancer cases, while discordant histology between the two breasts is even less common.

How was the patient’s cancer diagnosis confirmed?

A combination of imaging and biopsy confirmed invasive ductal carcinoma (left) and invasive lobular carcinoma with LCIS (right), along with bilateral axillary lymphadenopathy.

What treatments were initiated in this case?

The patient underwent neoadjuvant chemotherapy, followed by left radical mastectomy with axillary dissection. Hormonal therapy and adjuvant radiotherapy were then started, while right-breast surgery is pending.

Sep 23, 2026

Uploaded by awa