Triple-negative breast cancer history with later chest wall sarcomatoid carcinoma treated by embolization, ablation, and chemotherapy

What happened, in summary

This 45-year-old woman had a family history of breast cancer and was diagnosed after finding a lump in the outer quadrant of her left breast. Punch biopsy confirmed invasive breast carcinoma that was ER-negative, PR-negative, and HER2-negative. She received neoadjuvant chemotherapy with docetaxel, doxorubicin, and cyclophosphamide every 3 weeks for 6 cycles, followed by modified radical mastectomy in November 2018. Postoperative pathology showed no definite residual breast tumor, only focal fibrous tissue hyperplasia and foam cell aggregates. She then completed 25 cycles of radiotherapy. In April 2024, routine follow-up chest CT found a 13 x 8 mm nodule on the left chest wall. Observation was recommended, but by August 2024 the nodule had enlarged to 23 x 14 mm, showed peripheral enhancement, and invaded the adjacent rib. In September 2024, she underwent multimodal interventional treatment. A microcatheter was advanced into the tumor-supplying intercostal artery, Lipiodol and Embosphere microspheres were used for marking and embolization, CT-guided biopsy was obtained, and radiofrequency ablation was performed with local protection using subpleural isolation fluid. Pathology showed sarcomatoid carcinoma or undifferentiated sarcoma, with weak ER positivity, PR negativity, HER2 negativity, Ki-67 of 10%, TRPS1 expression, and GATA3 negativity. A December 2024 biopsy showed fibrous tissue, carbon deposition, and necrosis. She then received albumin-bound paclitaxel plus cisplatin. The combined approach addressed diagnosis and local control at the same sitting while limiting pleural and nerve injury. By February 2025, the lesion had decreased to about 13 x 7 mm, with no peripheral or distant metastatic foci seen.