A 63-year-old patient with a history of intolerance to diclofenac and Clamoxyl, arthrosis, and underwent tunnel syndrome surgery.
Gynecologic history: menarche at age 12 and at age 53.
Seven pregnancies and seven abortions due to probable incompatibility of HR.
In January 2001 she was operated on for ductal carcinoma of the right breast with conservative surgery (fouro-interno quadrant resection plus axillary lymphadenectomy).
It was a tumor of 2.2 cm histological grade II and nine axillary staging isolated tumor-free lymph nodes (T2N0M0).
Hormonal receptors were positive.
The patient was then treated with chemotherapy according to the CMF scheme for 6 cycles and concomitant radiotherapy (tangential with photons of 6 VM being 50.4 Gy plus boost of 16.2 Gy with electrons of 10 MeV).
Tamoxifen treatment and periodic reviews were followed.
In January 2005, the patient presented with a hard, ill-defined nodule in the supero-externe quadrant, located in the right breast before the appointment.
Mammography showed a higher density of the right breast and MRI showed a mass of 5 cm in diameter suggestive of fat necrosis.
Fine needle aspiration cytology is positive for ductal carcinoma.
Right radical mastectomy was performed with the anatomopathological result of moderately differentiated epidermoid carcinoma, primary of the breast, keratinizing carcinoma of 6.6x5x4 cm pure muscle margin and focal surgical resection achieved.
Axillary dissection was not performed.
Hormonal receptors were negative.
The patient was then treated again with radiotherapy of the chest wall using tangential fields with photons of 6 MV with reduced fields, given the previous radiotherapy history in this area and a dose of 50.4 Gy was administered.
At the end of the treatment she presented radiodermitis GIII at the axillary level that required local cures, and radiodermitis GI in the rest of the field.
