A Well Disguised Pleural Metastasis of Breast Carcinoma

Distant metastasis of breast carcinoma frequently occurs within five years after the diagnosis of the primary tumor. A 58-year-old female sharing a history of mastectomy for invasiveductal carcinoma six years previously admitted to our clinic with dyspnea progressively ongoing forpast two weeks. A right-sided massive pleural effusion was diagnosed and also pleural catheterdrained. Radiologic studies and cytological examination of the fluid did not introduce any evidenceof malignancy while she lately underwent thoracoscopy for the residuary effusion and atelectasis.Pathological study of the punch biopsies through the parietal pleura reported the pleural metastasis of the breast carcinoma but still negative evidence of malignancy for the pleural fluid. After discharge, evaluation with positron emission tomography also did not verify an uptake in any of thepleura, lungs or primary malignancy site. This event is of importance revealing that the patientssharing a past of malignancy should be approached with more caution and suspicion since the routine diagnostic algorithms pending to be reliable may not be applicable for all patients