A case of recurrent breast carcinoma where the initial manifestation was a pleural effusion 23 years after surgery

Abstract

The patient was an 85-year-old woman who had undergone a surgery for breast cancer at age 63. When she visited a clinic with a chief complaint of dyspnea, chest x-ray showed a possible left pleural effusion. She was referred to our hospital for the further evaluation and management. On admission thoracentesis was performed, and the cytology of the pleural effusion was diagnosed as Class V (adenocarcinoma). As dyspnea resolved she was discharged and followed up as an outpatient. However, scattered small skin spots on the left anterior chest and enlarged lymph nodes of the left axilla were noted 10 months after. Biopsy of the skin lesion revealed metastatic skin cancer (consistent with adenocarcinoma, metastatic breast cancer). She lives with no impairment in her activities of daily living one year after the event of pleural effusion, and is followed up as an outpatient receiving letrozole.