Increasing Pulmonary Infiltrates in a 72-Year-Old Woman With Metastatic Breast Cancer

A 71-year-old woman, nonsmoker, with a history of metastatic breast cancer was referred for evaluation of worsening pulmonary infiltrates. She described slowly increasing exertional dyspnea and cough in the preceding 3 months. Twenty-two years before, she had been diagnosed with invasive ductal carcinoma of the left breast, for which she underwent a left modified radical mastectomy and prophylactic right simple mastectomy and bilateral breast reconstruction using silicone implants. She subsequently underwent combination chemotherapy. She did well during the following 7 years until an enlarging liver lesion was noted that proved to be metastatic breast cancer, for which she underwent a right hepatectomy. Five years later, she developed intrathoracic and supraclavicular lymphadenopathy, a left pleural effusion, and cervical spine lesions. A biopsy specimen from a supraclavicular lymph node showed metastatic breast cancer, for which she started letrozole therapy with resolution of intrathoracic findings. Twelve months before presentation she underwent bilateral capsulectomy with silicone implant exchange because of pain from implant contracture. Her medications included letrozole, 2.5 mg once a day, and vitamin and Chinese herbal supplements. Her family history was positive for breast cancer in her maternal grandmother.