case_images: PMC10676630_01
case_images: (A-C) Representative CT images scanned at first diagnosis (August 2022). (A) Axial view showing a 0.6-cm tumor (yellow arrow) at the right lower out quadrant of the breast. (B) Coronal and (C) axial views showing right-sided axillary breast cancer (yellow arrow). (D) Clinical photograph taken at the time when the patient was referred to our clinic (February 2023). A solitary and pedunculated mass was seen in the upper external quadrant of the right breast. (E and F) Representative CT images of the (E) coronal and (F) axial views showing an enlarged breast cancer, unresponsive to chemotherapy and immunotherapy (February 2023). CT indicates computed tomography.
case_images: 10.1177_11782234231215183-fig1.jpg
case_images: PMC10676630_01_10.1177_11782234231215183-fig1.jpg
case_images: fig1-11782234231215183
case_images: The patient was first diagnosed in another hospital with a multicentric breast tumor in August 2022, showing a 0.6 cm tumor at the right lower out quadrant of the breast (Figure 1A) and a large mass of 4.5 x 3.0 x 3.5 cm in her right axilla (Figure 1B and C). On physical examination, a pedunculated mass occupied her right axilla, which was tender and fixed to the chest wall (Figure 1D). The patient was given a single regimen of carboplatin (area under the curve [AUC] = 4; 500 mg), paclitaxel (80 mg/m2), and pembrolizumab (100 mg) 1 day after the diagnosis of metaplastic breast carcinoma, but the tumor was still gradually enlarged, as a CT scan performed 1 week after the treatment showed that the tumor had grown to 9.4 cm (Figure 1E and F).
case_images: (A-B) Clinical photograph taken at the surgery (March 2023). (A) Right total mastectomy and axillary lymph node dissection were performed, but part of the tumor tissue (yellow arrow) was left behind on the major nerves and axillary vessels. (B) Breast with a nipple and areola-containing overlying skin was resected with 5 axillary lymph nodes. B indicates brachial plexus; LT indicates long thoracic nerve.
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case_images: PMC10676630_01_10.1177_11782234231215183-fig2.jpg
case_images: fig2-11782234231215183
case_images: However, because the tumor had already adhered to the patient's brachial plexus and axillary vessels, part of the tumor tissue remained on the nerves, as the patient refused forequarter amputation (Figure 2A). A breast with a nipple was resected along with 5 axillary lymph nodes (Figure 2B).
case_images: Representative CT images of the coronal view showing the regrowing of right breast cancer (red arrow). The scan was performed on the 25th day after the surgery (March 2023). CT indicates computed tomography.
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case_images: fig3-11782234231215183
case_images: Examination revealed a mass-like lesion of 13.0 cm in diameter on her right axilla and a skin nodule in her right upper arm near the axilla (Figure 3).