American Journal of Medical Case Reports, 2017, Vol. 5, No. 12, 301-303 Available online at http://pubs.sciepub.com/ajmcr/5/12/5 ©Science and Education Publishing DOI:10.12691/ajmcr-5-12-5 Synchronous Bilateral Breast Cancer (SBBC): Report of a Case with Review of Literature Mazaher Ramezani 1 , Akram Amiri 2 , Farhad Kavousi 1 , Masoud Sadeghi 3,* 1 Molecular Pathology Research Center, Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran 2 Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran 3 Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran *Corresponding author: Sadeghi_mbrc@yahoo.com Abstract The incidence of synchronous bilateral invasive breast cancer (SBBC) is reported to range from 0.8%-3.0%. Lower disease-free survival and high rates of distant metastasis is a recognized feature of bilateral synchronous tumors, which therefore have a worse overall survival compared to unilateral tumors. Early detection of the contralateral tumor is of utmost importance emphasizing the significance of breast self-examination. Here we report a case of SBBC with invasive ductal carcinoma on both sides in a 50-year-old lady. The pathology report on both sides was infiltrating ductal carcinoma and ductal carcinoma in situ, nuclear grade of ІІ/ІІІ and histologic grade of II/III. Perineural invasion was present on both sides but vascular invasion only on the right side. In conclusion, SBBC is rare, but is important because it may have worse prognosis, different hormone receptor status and treatment modality. Early detection with breast self-examination is highly emphasized. Keywords: synchronous, bilateral, breast cancer, case report Cite This Article: Mazaher Ramezani, Akram Amiri, Farhad Kavousi, and Masoud Sadeghi, “Synchronous Bilateral Breast Cancer (SBBC): Report of a Case with Review of Literature.” American Journal of Medical Case Reports, vol. 5, no. 12 (2017): 301-303. doi: 10.12691/ajmcr-5-12-5. 1. Introduction Bilateral breast cancer (BBC) incidence is estimated to be between 0.3 to 12% [1]. It is categorized as synchronous bilateral breast cancer (SBBC) or metachronous bilateral breast cancer (MBBC). The incidence of SBBC is 1% and that of MBBC 7.0 % [2]. Different publications suggest the same time to the same year for considering SBBC. Most of the publications proposed the contralateral tumor that was detected within the first 6 months as SBBC, tumors that developed after 6 months as MBBC [3]. The incidence of SBBC is reported to range from 0.8%-3.0%; largely reflecting differing definitions used for synchronous diagnoses, with cutoffs ranging from within 3-12 months of initial diagnosis [4]. Synchronicity/ meta chronicity are usually associated with local and lymphatic spread and with blood-borne spread to lungs, bones, and liver [5]. SBBC is an uncommon presentation, and the management of patients with this disease is not well established. Lower disease-free survival and high rates of distant metastasis is a recognized feature of bilateral synchronous tumors, which therefore have a worse overall survival compared to unilateral tumors [6]. In SBBC patients, molecular analysis showed discordant mutations in all cases, supporting the diagnosis of de novo bilateral primary BCs. In patients with lymph node metastases, the primary BC and metastases shared the same mutations, revealing a metastatic lesion [7]. Contradictory data exists concerning the prognosis of patients with SBBC. Most authors report a worse prognosis for SBBC patients compared to unilateral BC patients. There are a few studies that did not support these findings [8]. The data indicate that multifocal (MF), multicentric (MC), and SBBCs are more aggressive and have an equivalent or moderately poorer survival rate compared with unilateral cases [9]. Here we report a case of SBBC with invasive ductal carcinoma on both sides in a 50-year-old lady. 2. Case Report A 50-year-old lady was admitted in surgery department with chief complaint of bilateral palpable breast masses since 6 months ago on June 7 th , 2016. The masses were non-tender and without discharge. She was a housewife, married and was living in a village near Harseen, a city in Kermanshah province, Iran. She was the first of the seven sisters. There was no family history except for cystic lesion of the breast in the 4 th sister without any treatment or follow-up. There was no past medical or drug history. She was not smoker or opium addict. Physical examination was unremarkable except for bilateral breast masses measuring about 5.5 and 5 cm in right and left breasts, respectively. The patient underwent surgery on June 9 th 2016 with frozen section study. On the right side, the gross specimen consisted of a piece of fibro-fatty tissue measuring 5*4*1.5 cm containing two firm masses measuring 2.5 and 1.6 cm with fatty tissue invasion. On the left side, the gross specimen consisted of a piece of fibro-fatty tissue measuring 4*3*1 cm with a firm creamy