Multidisciplinary approach to uncommon, widely metastatic breast cancer

Worldwide, breast cancer represents the most common malignancy in women. Most diagnoses can be made relatively early. However, aggressive metastatic disease is still possible. We report an unusual case of a neglected 69-year-old woman with an intensely malodorous right breast, back pain, and shooting pain in both of her legs. After obtaining history, clinical examination, magnetic resonance imaging and CT scan, she was found to have widely metastatic breast cancer (ER/PR positive, HER-2 negative, 43% Ki-67), with metastases in vertebral bodies of T1/T4, pleura, lungs, liver, mediastinal and axillary lymph nodes, compression pathological fractures of T12/L3, and an expansive, destructive sacral metastasis. She underwent a thoracolumbar surgical fixation for her lower spine and radiotherapy for the T1 metastasis. She received aromatase inhibitor therapy followed by palliative mastectomy. Here, we reviewed the diagnostic steps, management, multidisciplinary approach and the relevant literature of this rare presentation of a destructive, multi-metastatic breast cancer.