Eight years ago she noticed a lump in her left breast. After mammography, aspiration cytology and physical examination a 3-4 cm diameter tumor has been revealed in the outer, upper quadrant of the left breast, so mastectomy and axillary block dissection was performed.

The histological diagnosis was mixed carcinoma (ductal and lobular), pT2, pN1(3/4).

After surgery she received postoperative irradiation (left chest wall, supraclavicular region, axilla, 50-50 Gy).

She received CMF chemotherapy and took Tamoxifen for 4 years.

Seven years later, during a routine complex breast examination, the thrombosis of the left jugular vein has been detected by ultrasound. In its background, a lymph node conglomerate has been revealed that narrowed the upper mediastinum, without other distant metastases (Figure 1). Hormone therapy was started with an aromatase inhibitor (letrozole). Half a year later CT showed complete regression and nearly complete recanalization of the subclavian vein (Figure 2). Certainly we sustained hormone therapy.

One year later she presented with progressive dyspnea and cough. She noticed a painful swelling at the border of the sternum and the clavicle. This time multifocal pulmonary, osseal and hepatic progression has been shown.

She received 8 cycles of GET (Gemzar, Epirubicin, Taxol) chemotherapy.

This resulted in complete remission of the lung metastases (Figure 3) and partial remission of the hepatic metastases (Figure 4) that has lasted for 8 months after the end of treatment.

Half a year later she presented with nausea and vomiting, her symptoms were intensified by postural change and head movement. Cranial MRI revealed a metastasis in the right hemisphere of the cerebellum and multifocal metastases in the cerebrum (Figure 5). Whole brain irradiation and dehydration improved her neurological symptoms, but the disseminated disease caused the patient’s death within a few months.

Edited by Prof. Dr. Zsuzsanna Kahán