Triple-Negative Breast Cancer in Pregnancy: A Case Report and Narrative Review of Multidisciplinary Management in a Resource-Limited Setting.

Pregnancy-associated breast cancer is an uncommon clinical entity, and management is particularly challenging when associated with triple-negative breast cancer (TNBC) because of its aggressive biology and limited targeted treatment options. We report a case of a 35-year-old gravida 2, para 1 female diagnosed with TNBC at 19 weeks' gestation, following a spontaneous conception after 12 years of subfertility. She presented with a progressively enlarging left breast and axillary mass. Imaging demonstrated a BI-RADS (Breast Imaging Reporting and Data System) 5 lesion, and core biopsy of the axillary lesion confirmed metastatic carcinoma with a triple-negative, high-proliferation-index immunophenotype (CK7+, GATA3+) supporting a breast primary. Staging with abdominal ultrasound and brain MRI showed no evidence of distant disease, and she was staged as clinical T2N1M0. Following multidisciplinary team discussion, neoadjuvant chemotherapy with epirubicin and cyclophosphamide was initiated at 19 weeks' gestation, administered as four cycles on a standard three-weekly schedule, before transitioning to weekly paclitaxel from 30 weeks' gestation. Maternal tolerance during the antenatal treatment course was satisfactory, and serial fetal surveillance (biometry, amniotic fluid assessment, and biophysical profile) remained reassuring throughout. Delivery by elective caesarean section was planned at 34 weeks' gestation, with definitive breast and axillary surgery deferred to the postpartum period. This case illustrates that guideline-concordant multidisciplinary chemotherapy administration is feasible during pregnancy, including in a resource-limited setting. As this report focuses on the antenatal diagnostic and treatment course, definitive delivery, neonatal, and postpartum oncologic outcome data were not available for inclusion and are acknowledged as a limitation. This report nonetheless contributes to the limited clinical literature on TNBC diagnosed during pregnancy, particularly from a resource-limited, non-tertiary setting.