49-Year-Old Patient's Pleomorphic Breast Relapse in Weeks
Following neoadjuvant chemotherapy, the patient achieved a partial pathologic response and underwent breast-conserving surgery with axillary lymph node dissection and radiotherapy.
After 6 years and 7 months, local recurrence in the right breast was identified, and the patient subsequently underwent mastectomy. However, 4 weeks later, metastasis to the contralateral breast was detected. An additional 13 weeks later, metastatic pleural tumours occupied approximately 70% of the thoracic cavity.
Only detailed pathologic analysis revealed the underlying diagnosis of pleomorphic breast carcinoma.
Nobuyuki Takemoto, MD, from the Department of Breast and Thyroid Surgery at Japan Medical Alliance East Saitama General Hospital in Satte, Japan, and colleagues documented the extremely rare case.
The Patient and Her History
The patient visited the hospital complaining of swelling and erosion of the right nipple. Her medical history included bilateral breast cancer diagnosed more than 6 years earlier. The right-sided tumour was the nonluminal type (oestrogen and progesterone receptor positive; HER2 3+; Ki-67, 31%), and the left-sided tumour was luminal A-like (oestrogen and progesterone receptor positive; HER2-; Ki-67, < 5%).
As neoadjuvant chemotherapy, four cycles of adriamycin and cyclophosphamide (60/600 mg/m²) every 3 weeks, followed by paclitaxel (80 mg/m²) and trastuzumab (loading dose 4 mg/kg, maintenance 2 mg/kg) weekly for 12 weeks, were administered. The patient achieved a clinical partial response on imaging.
Bilateral breast-conserving surgery and axillary lymph node dissection were performed. The pathologic evaluation of the therapeutic effect was grade 1 (right: ypT1bypN0M0, ypstageI; left: ypT1cypN0[i+]M0, ypstageI).
After radiotherapy (50 Gy in 25 fractions) of the residual mammary gland, trastuzumab (6 mg/kg) was administered. However, the patient requested to discontinue treatment after two courses. She was subsequently followed with endocrine therapy (tamoxifen).
Six years and 7 months after the initial operation, local recurrence occurred.
Findings and Diagnosis
On admission, all vital signs were within normal limits. Physical examination, including inspection, auscultation, palpation, and percussion, showed no abnormalities. Routine laboratory test results were unremarkable.
A CT revealed a swollen right nipple. and three stump cytology tests for erosion were negative, but the nipple itself showed a tendency to grow, so a core needle biopsy (CNB) was performed. Pathologic findings showed invasive carcinoma and suggested metaplastic carcinoma. As no metastases to other organs were found, a right mastectomy was performed. After chemotherapy with carboplatin, radiation therapy to the supraclavicular fossa was planned; however, 4 weeks after the operation, a round mass of approximately 1 cm was found in the left breast.
CNB revealed a suspicious malignant metaplastic carcinoma. It was determined that there was a high possibility of metastasis to the contralateral side, and a left mastectomy was performed. However, 12 weeks later, a left pleural tumour and a right chest wall mass appeared. After another 13 weeks, the left thoracic cavity was occupied by almost 70% of the pleural mass, and the right chest wall mass grew to 10 cm in size.
Furthermore, the white blood cell count rose rapidly to 98.8 × 103/µL, with 94.8% neutrophils, 2.5% lymphocytes, and 1.8% monocytes. Bone marrow metastasis was suspected, but bone marrow aspiration could not be performed due to the patient's poor general condition. The patient died 25 weeks after the diagnosis of local recurrence.
Pathologic examination revealed a pleomorphic carcinoma (PC) transitioning from ductal carcinoma, with a subtype of triple-negative breast cancer. Immunohistochemical staining showed positive expression of AE1/3 (anti-pan cytokeratin), beta-catenin, E-cadherin, and vimentin. Staining was negative for CAM5.2 (cytokeratin), HMB45 (human melanoma black 45), and LCA (leukocyte common antigen).
Discussion
'When a rapidly growing breast mass is encountered, it is necessary to consider PC as one of diagnostic candidate. Little research has been done on PC, particularly on diagnosis and therapy. Thus, further case accumulation and analyses are awaited to gain more insight on the characteristics of PC,' the authors wrote.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
a minute ago
- Medscape
Low Disease Activity Maintained Long Term With TNF Tapering
TOPLINE: A tapering strategy for TNF inhibitors maintained low disease activity in patients with psoriatic arthritis (PsA) and those with axial spondyloarthritis (AxSpA) over 24 months. Protocol-driven tapering achieved a greater reduction in the mean dose of TNF inhibitors than routine care tapering, with both methods equally effective for disease control. METHODOLOGY: Previous 12-month results from an open-label, noninferiority, pragmatic trial (January 2019 to July 2020) conducted in the Netherlands showed that tapering of TNF inhibitors was noninferior to continued dosing for maintaining low disease activity in patients with PsA or AxSpA. Participants in the original trial (aged 16 years or older with stable low disease activity for 6 or more months) were randomly assigned to either a treat-to-target tapering strategy (intervention) or a continuation of the original dose of TNF inhibitors (control). Tapering involved extending the interval between doses, leading to doses equivalent to 100%, 66%, 50%, 33%, or 0% of the defined daily dose. This observational extension of the original trial included 114 patients (mean age, 50 years; 79 from the intervention group and 35 from the control group) with PsA (n = 58) and AxSpA (n = 56), where the intervention group continued the tapering strategy, whereas the control group could attempt tapering (routine care tapering), with treatment decisions made collaboratively by physicians and patients. The primary outcome was the difference in the proportion of patients with low disease activity at 24 months between the intervention and control groups compared against a prespecified noninferiority margin of 20%. Secondary outcomes included differences in efficacy between the intervention and control groups determined using disease activity scores at 18 and 24 months, as well as the cumulative incidence of disease flare over 24 months. TAKEAWAY: At 24 months, 67% of patients in the intervention group and 72% in the control group maintained low disease activity (adjusted difference, 5%; P = .64). Over 24 months, 89% of patients attempted tapering, with no significant differences in adverse events between groups. No difference was noted in the percentage of patients achieving low disease activity between the intervention group with protocol-driven tapering at 12 months and the control group with routine care tapering at 24 months. The cumulative incidence of disease flare was 90% over 24 months. The mean dose of TNF inhibitors increased in the intervention group from 52% to 66% of the defined daily dose from 12 months to 24 months (difference, 14%; P < .0001). However, the mean dose was lower with protocol-driven tapering in the intervention group at 12 months than with routine care tapering in the control group at 24 months (P = .0001) and lower with routine care tapering vs no tapering in the control group (P = .0007). IN PRACTICE: '[T]hese data indicate that a taper-to-target strategy is effective and leads to substantial TNF inhibitor dose reduction, but optimal execution of such a strategy in routine care is more challenging than in the context of a clinical trial,' the authors of the study wrote. 'Considering the risks and benefits of tapering, we suggest that disease activity-guided tapering could enable more optimized and personalized treatment in patients with psoriatic arthritis and axial spondyloarthritis.' SOURCE: The study was led by Amy C.D. Peeters, MD, and Celia A.J. Michielsens, MD, PhD, Sint Maartenskliniek in Nijmegen, the Netherlands. It was published online on July 24, 2025, in The Lancet Rheumatology. LIMITATIONS: Measurements for disease activity were missing at 18 and 24 months. The absence of validated flare criteria until 2022 may have led to an overestimation of flare incidence. Radiographic progression was not assessed at the 24-month follow-up. Allowing tapering in the control group during the extension phase reduced the difference between groups. DISCLOSURES: The study was funded by ReumaNederland. Some authors reported receiving grants from multiple companies including Novartis, Eli Lilly and Company, and AbbVie to their institution. One author reported receiving support for attending meetings and/or travel from Pfizer, Novartis, and UCB. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Associated Press
2 minutes ago
- Associated Press
CCHR Calls for Clinical and Financial Audit of U.S. Mental Health System
LOS ANGELES, Calif., Aug. 11, 2025 (SEND2PRESS NEWSWIRE) — The Citizens Commission on Human Rights International (CCHR) is calling for a clinical and financial audit of the U.S. mental health system, warning that plans to involuntarily commit individuals experiencing homelessness could worsen mortality rates while escalating healthcare costs. The group emphasizes that psychotropic drugs commonly used in psychiatric facilities carry serious—often fatal—risks, especially when administered without thorough medical screening. While no federal agency tracks national mortality rates among people experiencing homelessness, studies estimate a death rate between 3% and 8%.[1] CCHR warns this could rise if individuals are forcibly institutionalized and prescribed high-risk antipsychotics—known to cause fatal conditions such as Neuroleptic Malignant Syndrome (NMS). High doses of antipsychotics are associated with significantly increased mortality, especially in young adults.[2] NMS has a mortality rate of up to 10%, according to The Handbook of Clinical Neurology.[3] Symptoms include hyperthermia, muscle rigidity, delirium, and coma. An estimated 100,000 Americans have died from NMS.[4] Another long-term risk is Tardive Dyskinesia (TD), a debilitating movement disorder that resembles Parkinson's disease and affects at least 25% of those taking antipsychotics.[5] TD can persist long after the drugs are discontinued. With over 11 million Americans prescribed antipsychotics, this translates to approximately 2.75 million potentially suffering from TD and more than 1.1 million at risk of NMS.[6] 'Drug-induced brain damage is being disguised as 'mental illness,'' Jan Eastgate, president of CCHR, stated. 'Tragically, the homeless are likely to be targeted for these toxic treatments if hospitalized.' CCHR points to concerning practices in California, where psychiatric outreach teams inject homeless individuals with long-acting antipsychotics—under the euphemism of 'street medicine.' These injections can remain active for weeks, with individuals unable to stop the drugs' effects. A core concern is psychiatry's frequent failure to conduct adequate medical assessments before diagnosing and drugging. A landmark California study (1983–84) found 39% of individuals admitted to state psychiatric hospitals had undiagnosed physical illnesses. Medical staff often failed to identify these, highlighting systemic diagnostic failure.[7] The study led to the development of the Mental Health Medical Evaluation Field Manual, which provided a low-cost screening algorithm capable of detecting 90% of these medical issues. There is no evidence that the manual is still in use. CCHR is calling for it to be implemented nationwide. 'This one change—comprehensive physical exams—could dramatically reduce misdiagnosis, psychiatric hospitalizations, and iatrogenic harm,' Eastgate said. TheDiagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) admits that medical conditions can mimic psychiatric symptoms and must be ruled out. Psychiatrists use the term anosognosia —an alleged inability to recognize one's illness—as a rationale for forced treatment.[8] There is no objective test to confirm this theory. There are concerns about conflicts of interest in psychiatric diagnosis. Of the DSM-5 task force members, 69% had financial ties to pharmaceutical companies. They received $14.2 million—of which $8.4 million went to those determining criteria for drug-induced movement disorders like TD.[9] Meanwhile, mental health spending continues to soar with little to no measurable improvement in public outcomes. Treatment is often significantly more expensive than general medical care.[10] In 2013, U.S. mental health costs reached $201 billion—more than cancer and heart disease. By 2022, that figure had ballooned to $329 billion—a 94% increase in less than a decade, while the population grew by only 6.4%. The consequences extend beyond cost. Antidepressants—sometimes prescribed with antipsychotics—were implicated in 5,863 overdose deaths in 2022, a 226% increase since 2000.[11] They can also increase the risk of repeated suicide attempts by 50%.[12] Psychiatric outcomes remain dismal. The U.S. has the highest suicide rate among developed countries and the second-highest drug-related death rate.[13] A third of individuals in psychiatric hospitals are re-admitted within a year,[14] and 31% are assaulted while institutionalized.[15] CCHR urges policymakers to: 'We need to abolish coercive psychiatric powers and first examine the harm already being done—and how much it's costing lives and taxpayers,' Eastgate concluded. CCHR's co-founder, the late psychiatrist Dr. Thomas Szasz, stated: 'There is neither justification nor need for involuntary psychiatric interventions…. All history teaches us to beware of benefactors who deprive their beneficiaries of liberty.' Founded in 1969 by the Church of Scientology and Prof. Szasz, CCHR is a non-profit mental health watchdog with chapters across six continents. Its mission is to expose and eradicate abuse in the mental health field and to restore human rights and dignity to mental health care. To learn more, visit: Sources: [1] [2] 'Antipsychotic Medications and Mortality in Children and Young Adults,' JAMA Psychiatry, 2024; [3] 'Chapter 25 – The psychopharmacology of catatonia, neuroleptic malignant syndrome, akathisia, tardive dyskinesia, and dystonia,' Handbook of Clinical Neurology, Vol 165, 2019, [4] Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, (Perseus Publishing, New York, 2002), pp. 207-208 [5] Handbook of Clinical Neurology, Vol 165, 2019 [6] [7] MEDICAL EVALUATION FIELD MANUAL, Stanford, CA, 1991, pp. 3-4, 18. [8] Thomas Szasz, MD, Coercion as Cure: A Critical History of Psychiatry, 2007, p. 22 [9] 'Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis,' BMJ, 10 Jan. 2024, [10] 'Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement,' Milliman Research Report, C, 20 Nov. 2019 [11] [12] [13] [14] 'Readmission of Patients to Acute Psychiatric Hospitals: Influential Factors and Interventions to Reduce Psychiatric Readmission Rates,' Healthcare (Basel), 2022 Sep 19;10(9), [15] 'Fear, Neglect, Coercion, and Dehumanization: Is Inpatient Psychiatric Trauma Contributing to a Public Health Crisis?' Journal of Patient Experience, 9 Aug. 2022, MULTIMEDIA: Image link for media: Image Caption: Mental health industry watchdog, CCHR, is calling for a clinical and financial audit of the U.S. mental health system, warning that involuntary commitment of the homeless could raise mortality and healthcare costs. NEWS SOURCE: Citizens Commission on Human Rights Keywords: General Editorial, Citizens Commission on Human Rights, CCHR International, Jan Eastgate, U.S. mental health system, homeless, LOS ANGELES, Calif. This press release was issued on behalf of the news source (Citizens Commission on Human Rights) who is solely responsibile for its accuracy, by Send2Press® Newswire. Information is believed accurate but not guaranteed. Story ID: S2P128343 APNF0325A To view the original version, visit: © 2025 Send2Press® Newswire, a press release distribution service, Calif., USA. RIGHTS GRANTED FOR REPRODUCTION IN WHOLE OR IN PART BY ANY LEGITIMATE MEDIA OUTLET - SUCH AS NEWSPAPER, BROADCAST OR TRADE PERIODICAL. MAY NOT BE USED ON ANY NON-MEDIA WEBSITE PROMOTING PR OR MARKETING SERVICES OR CONTENT DEVELOPMENT. Disclaimer: This press release content was not created by nor issued by the Associated Press (AP). Content below is unrelated to this news story.
Associated Press
2 minutes ago
- Associated Press
Medical Teams International Launches Campaign to Raise $1 Million USD by August 31
Portland, Oregon USA, Aug. 11, 2025 (GLOBE NEWSWIRE) -- Medical Teams International, a global health and humanitarian relief organization, has launched 'Rise to the Moment,' a fundraising campaign to help drive our urgent work to provide compassionate, life-saving healthcare to people in crisis around the world. The goal is to raise $1 million USD by August 31, leveraging a $500K match donation made to the campaign. Severe Funding Crisis The global humanitarian aid sector has faced enormous funding challenges in 2025, due to the U.S. government's dissolution of USAID, deep funding cuts to many UN agencies, and decreased availability of funds worldwide. Despite sharply rising needs due to hunger, conflict, and displacement, the U.S. and the international community are pulling back aid, impacting some of the world's most vulnerable people. Among them are roughly 122 million people around the world who have been forced to flee their homes. Families and individuals who have been displaced experience high levels of physical and emotional distress and are at greater risk of life-threatening illnesses. In Uganda, home to nearly 2 million refugees, stockouts of key medication and supplies due to procurement delays by UNHCR are increasing. Also, high workloads for medical staff – 75 consultations per clinician per day last quarter – mean patients who are fortunate enough to be seen are receiving less time and attention. Medical Teams' Work Medical Teams works in seven countries including the U.S., and our dedicated local staff and community health volunteers provide essential healthcare to refugees, internally displaced people, and host communities. For 45 years, we've been saving lives, alleviating suffering, and restoring human dignity by offering comprehensive services in health, nutrition, and mental health. We serve in complex humanitarian settings where healthcare systems have been disrupted, access to care is limited or nonexistent, and external assistance is required. Available Aid Difficult to Access Many of Medical Teams' health services fit into the current administration's definition of life-saving work and have thus been deemed eligible for humanitarian waivers and reimbursement of program expenses incurred earlier this year. However, many do not qualify but are potentially life-saving. These activities, like addressing mental health conditions such as PTSD, as well as moderate malnutrition, are the pillars that support the safety and well-being of children and families at border points and in refugee camps and settlements. For example, food rations have been scaled back significantly and nutrition supplements for pregnant and lactating women are no longer available in many areas. 'All of our staff and volunteers are determined to rise to the moment to meet more needs and save more lives, and we're so thankful for the donors who have already joined us,' said Eric Ha, Medical Teams President & CEO. 'However, as we navigate this time of great uncertainty, we need many more people of goodwill to join us. We believe in the American people's compassion, generosity, and sense of common humanity. If there was ever a time to demonstrate those virtues, it's now.' $500K Campaign Match Medical Teams is grateful that an anonymous donor has committed a $500,000 match to the Rise to the Moment campaign. We aim to raise another $500,000 by August 31 to maximize the donation, enabling us to provide vital health services to people in crisis and facing vulnerability. For more information or to give, visit and About Medical Teams International Founded in 1979, Medical Teams International provides life-saving medical care for people in crisis, such as refugees, internally displaced persons, and survivors of conflict zones and natural disasters. Daring to love like Jesus, we care for the whole person and serve all people. Learn more at and on social media using @medicalteams. Attachments Karen Piatt Medical Teams International 2067080355 [email protected]
