Aggressive breast cancer presenting with severe skin infection

What happened, in summary

A woman in her 70s had lived with a slowly growing right-breast mass for about 10 years without screening or treatment. She came to the emergency department after 4 days of fever, confusion, worsening pain, and pus draining from the mass. She was septic. The tumor measured about 15 cm, had grown through the skin, and was surrounded by dead tissue and a severe soft-tissue infection.

She underwent emergency right total mastectomy with removal of part of the pectoralis major muscle. A wound vacuum was placed. Three days later, she returned to the operating room for further removal of unhealthy tissue and closure of the wound.

Pathology showed a 15 cm grade 2 invasive mucinous carcinoma, classified as T4c cN0 M0. The tumor was 99% estrogen receptor-positive, 99% progesterone receptor-positive, HER2-negative, and had a Ki-67 of 3%. Three interpectoral lymph nodes contained no cancer. CT and bone scanning found no distant metastases.

She recovered from the sepsis and surgery and began anastrozole. A later suspicious axillary node was benign on biopsy. She then started postmastectomy radiation. Abemaciclib was planned after radiation but had not yet begun. The plan was to continue anastrozole for 5 years. Her care remained ongoing for high-risk, locally advanced but non-metastatic breast cancer.

The emergency priority was control of sepsis and removal of infected, dead tissue. After recovery, care shifted to reducing recurrence risk with radiation and long-term hormone treatment. Three interpectoral nodes and a later axillary-node biopsy were negative.