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4/16/2024. Bilateral diagnostic mammograms and ultrasound performed showing category C breast density. 6 cm irregular mass/area of architectural distortion in the left upper inner breast in the area of clinical concern. On left breast ultrasound, at the 10 o’clock position 7 cm from the nipple there was a 4.4 x 2.3 x 3.6 cm solid mass corresponding to the mammographic finding.

4/24/2024. Ultrasound-guided biopsy of the left breast. Left axillary lymph node core biopsy showing metastatic carcinoma

5/10/2024. Bilateral breast MRIs performed show extensive poorly defined non-mass enhancement in the upper inner left breast. Overall dimensions of the lesion approximately 7.2 x 6.2 x 3.5 cm

5/15/2024. PET-CT scan Multiple hypermetabolic left breast nodules consistent with multifocal left breast. Hypermetabolic left axillary nodes concerning for malignancy.

05/13/2024 Left breast punch biopsy at OSH unremarkable, negative for dysplasia or malignancy. Minute fragments of invasive breast carcinoma involving dermal tissue. The tumor cells are positive for pancytokeratin and GATA3

5/22/2024 Initial Diagnosis Malignant Neoplasm Of Breast Upper Inner Quadrant Female Left (HCC)

6/18/2024 Enrolled on a clinical trial at Moffitt Cancer Center. 3 vaccines for 4 weeks followed by neoadjuvant chemo immunotherapy with pembrolizumab every 21 days in combination with Taxol and carboplatin weekly times 12 followed by AC x4.

7/2/2024 Started chemo

11/26/2024 Completed cycle 4 of dose dense AC. 20% dose reduction due to hospitalization wit neutropenic fever.

1/2/2025 Patient had bilateral mastectomy with left targeted axillary dissection with flap reconstruction.

The pathology from the left breast showed residual invasive carcinoma measuring 3.5 mm post neoadjuvant therapy. Treatment changes in a fibrotic tumor bed measuring 8.5 x 5 cm.

2/19/2025 Patient had left axillary dissection with reverse arm mapping with 8/8 positive nodes for metastatic carcinoma largest metastatic tumor deposit 0.95 cm.

3/13/2025 New hypermetabolic lesion involving the left hepatic lobe with corresponding hypodensity on CT measuring 1.9 x 1.8cm

3/20/2025 MRI Abdomen w/wo Contrast Hypovascular lesion measuring 1.7 cm at the liver dome.

4/10/25 CT Pulmonary Angiography: There are multiple pulmonary nodules identified within the RIGHT lung which are increased in number and size from prior exam.

There is an index one within the RIGHT upper lobe which measures 0.4 cm in comparison to prior exam measurements of 0.2 cm. There is another one identified within the RIGHT middle lobe which measures 0.4 cm in comparison to prior exam measurements of 0.2 cm.

There is a nodule identified within the LEFT upper lobe which measures 0.3 cm. Within the LEFT lower lobe there is a 0.3 cm pulmonary nodule in comparison to prior exam measurements of 0.1-0.2 cm.

Upper Abdomen: There is a mass identified within segment 4A the liver which measures 2.1 cm in comparison to PET/CT from 03/13/2025 when this measured 1.6 cm and demonstrated FDG uptake.