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Cancer on the trunk with left humerus exposed and gangrenous arm

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This is a severe case of metaplastic breast carcinoma with upper limb gangrene.

Metaplastic breast carcinomas are rapidly growing tumors with histological heterogeneity, and triple negative receptor status.
A 22-year-old nulliparous Chinese woman with no significant family history of cancer
presented to a private medical center with a painless 5 cm swelling in the left breast.
The swelling, which was first noticed 3 months earlier, increased in size gradually.
Core biopsy of the swelling confirmed an infiltrating ductal carcinoma with triple negative receptor status for ER, PR, and HER2 receptors.

Two weeks into her neoadjuvant chemotherapy, she complained that the left breast mass had significantly increased in size from the initial 5 cm to 10 cm in diameter. She also developed a swelling in the left axilla and a cytology of the left ancillary lymph node revealed metastatic carcinoma.
A decision was made to proceed with left mastectomy and axillary clearance.
Six weeks following surgery, she underwent adjuvant chemotherapy.

Four months later, she presented to a district hospital with complaints of pain over the left chest wall and inability to move her left upper limb. On examination, a large fungating mass with a necrotic patch was seen at her left chest wall, extending into the axilla. The tumor had infiltrated the anterior chest wall and was even seen over the posterior chest wall. The left upper limb was cold, pale, and mottled with patchy areas of necrosis.
There was no motor or sensory function in the left upper limb.

The left upper limb tissue gradually became waxy and soft. The flesh over the limb also began to spontaneously separate from the underlying bone, exposing parts of the humerus. The patient eventually requested amputation of the left upper limb, as it was becoming increasingly difficult for her family and nurses to take care of the truncal lesions with the rotting flesh and fragile, non-functioning limb getting in the way. The amputation at the site of the exposed left humerus was performed under intravenous sedation.



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