Breast cancer and concurrent sarcoma of the femur: don't forget to put the patient in focus

If breast cancer is diagnosed symptoms are normally assumed to originate from the primary tumor. But what should be done with symptoms which have not been present at initial examination and are no signs for metastases? We present a case of a 39 year old woman with breast cancer and concurrent sarcoma of the femur.

Patient concerns:

At the age of 31 years the patient underwent bilateral mastectomy with primary implant reconstruction due to carcinoma in situ of the breast and high familiar risk (analysis without loss of function BRCA1/2). Eight years after surgery an invasive ductal carcinoma of the breast was diagnosed and skin-sparing mastectomy, axillary dissection and implant change on the right side were performed. (pT1a pN0 (0/17) cM0 R0 G1, HR positive, Her2 negative).

Few days after surgery patient reported a swelling of the left thigh. Imaging proposed a hematoma without known trauma in the patient's history. Due to accompanying anemia the surgeon on call decided to perform an evacuation of the hematoma. Histological results revealed the diagnosis of a sarcoma. Genetic analysis did not reveal any associations with known syndromes or genetic traits. Patient started chemotherapy in a special sarcoma department in Berlin.

Summary:

This case is a reminder for not focusing on cancer alone.