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Receptor conversion and vocal cord paralysis in a patient with breast cancer
  1. Harold Nathan Tan,
  2. Lance Isidore Garcenila Catedral,
  3. Rogelio Jr Velasco and
  4. Michael San Juan
  1. Division of Medical Oncology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines
  1. Correspondence to Dr Harold Nathan Tan; haroldnathantan{at}gmail.com

Abstract

Receptor conversion in breast cancer occurs in up to 32% of patients, resulting in ineffective therapy in the absence of corresponding biomarkers. We report a case of a middle-aged woman who presented with a 2-month history of hoarseness. Laryngoscopy demonstrated right vocal cord paralysis. Whole body positron emission tomography-CT (PET-CT) scan showed a hypermetabolic cervical lymph node, worrisome for metastasis. Biopsy of the cervical lymph node was consistent with metastatic carcinoma of the breast (GATA3 and mammaglobin positive, oestrogen receptor (OR)-positive, progesterone receptor-negative and human epidermal growth factor receptor 2 (HER2)-positive). She underwent targeted therapy with ado-trastuzumab emtansine every 3 weeks. Repeat PET-CT scan after 6 months showed stable disease. Reassessment of receptor status in metastatic breast cancer is encouraged to rule out receptor conversion. There is significant cross-talk between OR and HER2 signalling pathways, leading to treatment resistance. Close collaboration and teamwork among various subspecialties facilitate prompt management of patients with suspected metastatic breast cancer.

  • cancer intervention
  • breast cancer

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Footnotes

  • Twitter @lanceoncology

  • Contributors HNT, LIGC, RJV and MSJ contributed equally to the conceptualisation and design of the case report, to the review of related literature and to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.