PMC6106907_01
Aspect of the lesion in the admission of the patient.
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Hospital with a bulk tumor mass, which extended from the right breast to the right flank, friable, bleeding, and sore with a malodorous (Figure 1). She was undernourished (BMI 15,57/m2), in a regular, state feverish and pale +/4+. Her physical examination performed by medical equipment did not show alterations.
Chest tomography at the admission.
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The chest tomography showed the cystic injury and lungs without signs of metastasis (Figure 2).
Immediate postoperative.
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After a discussion of the medical board, a hygienic mastectomy, and reconstruction unilateral thoracoabdominal, the surgical specimen performed had the following dimensions: 14,5x12x9 cm and 1.375g (Figure 3).
Necrosis of the surgical flap (a) and final aspect after debridement (b).
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Two weeks after the surgical procedure (14  PO), the patient evolved with necrosis in part of the thoracoabdominal flap; it was necessary to perform the debridement of the necrotic area (Figures 4(a) and 4(b)).
Local recurrence (arrow).
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Despite the clinical improvement and stability, on the 38  PO clinical staff noted the appearance of ulcerated nodule of around 1 cm of diameter in in the right parasternal region, suggestive of local recurrence, which increased progressively, presenting a measure of around 3 cm at the moment of the patient discharge (Figure 5).
Chest tomography at the hospital discharge.
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Besides, during the hospitalization, small pulmonary lesions were identified on computed tomography, absent at the moment of the diagnosis, suggestive of tumor metastasis (Figure 6).
An aspect of the lesion in the readmission of the patient.
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Chest tomography in the rehospitalization.
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A new tomography was performed, presenting pulmonary extensive metastatic lesions, bilateral, besides the massive lesion (Figure 8).