ABSTRACT

It is important to follow breast cancer patients after their initial treatment as loco-regional recurrences are potentially treatable and local failure has shown to adversely affect overall survival. Herein, we present a 49-yearold premenopausal Caucasian woman who was treated with neoadjuvant chemotherapy, breast-conserving surgery (BCS), and adjuvant chemo-radiotherapy for invasive ductal carcinoma of the right breast in 1998 that subsequently developed a loco-regional recurrence eight years after treatment that presented with lymphedema and chest wall pain. Her clinical exams, yearly mammograms, consecutive chest x-rays, and bone scans did not reveal evidence of recurrent disease thus, for two years her symptoms were attributed to costochondritis by her primary care physician. She was evaluated in our lymphedema clinic with right arm lymphedema and persisting chest wall pain. A Flurodeoxyglucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) scan was performed and it revealed a soft tissue mass between the anterior costochondral junctions of the right sided 3rd and 4th ribs along the internal mammary chain. Fine needle aspiration biopsy confirmed an adenocarcinoma originating from breast. After complete chest wall mass resection and subsequent chemo-radiotherapy, she is free of symptoms. In conclusion, a careful clinical examination and accurate diagnostic work-up to exclude recurrence is essential in the follow-up of patients with a history of breast cancer, before accrediting symptoms to a non-cancerous etiology.