Chemoresistant Triple Negative Breast Cancer

A 39-year- old female presented with a 20-cm tumor of the right breast with matted right axillary lymph nodes. Core biopsy of the tumor confirmed invasive ductal carcinoma NST (no special type), triple negative, G3. Fine needle aspiration of the axillary lymph node mass confirmed metastasis. No metastatic spread was shown by computed tomography of the thorax, abdominal ultrasound or bone scan. BRCA1 and 2 testing was negative. She was referred for chemotherapy, but there was no response to anthracyclines, taxanes, vinorelbine and cisplatin . A toilet mastectomy was performed because the tumor was ulcerating and bleeding. The large tissue defect was filled with a latissimus dorsi flap incorporating a skin island and also an additional free skin flap harvested from the left inner arm. Histopathological examination showed a poorly- differentiated, invasive ductal NST, triple negative, Ki67 80%, 19.8x5.6x15.5 cm breast cancer. Ten axillary lymph nodes were removed, of which one contained a 6- cm metastatic node with capsular infiltration. The patient was referred for radiotherapy.