{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T15:08:42Z","timestamp":1780672122986,"version":"3.54.1"},"reference-count":15,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>A 51-year-old woman was admitted with a malodorous ulceration covering the whole area of both breasts, without visible breast contour or remnants of breast tissue. After excision of a skin nodule an invasive ductal carcinoma was diagnosed; grade-2, hormone receptor (HR)-positive, HER2-negative, Ki-67 at 25%. Computed tomography of the thorax and abdomen showed pulmonary and osseous metastases. Six cycles of systemic chemotherapy with epirubicin and cyclophosphamide at three-week intervals were administered, followed by endocrine therapy with letrozole. Almost four years later, palbociclib became available and it was added to the patient\u2019s treatment. Loco-regional and distant disease control was achieved attaining maximum response at 11 months after initial diagnosis and since then the patient remains progression-free with good quality of life for more than eight years. This is to the best of our knowledge an extreme case of primary metastatic ulcerative breast cancer with complete local tissue destruction and markedly prolonged progression-free survival. As this is a single-case clinical observation, any conclusions have limited generalizability. Given the rarity of primary metastatic ulcerative breast cancer there are no specific evidence-based treatment guidelines available and published studies have high heterogeneity and low level of evidence, necessitating multidisciplinary approach on a case-by-case basis.<\/jats:p>","DOI":"10.3390\/diagnostics16111744","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T14:10:42Z","timestamp":1780668642000},"page":"1744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Extreme Clinical Diagnosis: Primary Metastatic Breast Cancer with Complete Bilateral Breast Contour Elimination and Ulceration"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9357-1950","authenticated-orcid":false,"given":"Menelaos","family":"Zafrakas","sequence":"first","affiliation":[{"name":"School of Health Science, International Hellenic University, 57400 Thessaloniki, Greece"},{"name":"European Interbalkan Medical Center, 55535 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros","family":"Argyriou","sequence":"additional","affiliation":[{"name":"European Interbalkan Medical Center, 55535 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2153-2818","authenticated-orcid":false,"given":"Panayiota","family":"Papasozomenou","sequence":"additional","affiliation":[{"name":"School of Health Science, International Hellenic University, 57400 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Emmanouilides","sequence":"additional","affiliation":[{"name":"European Interbalkan Medical Center, 55535 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1046\/j.1524-4741.2001.07608.x","article-title":"Ulcerative breast cancer: Case report and review of management","volume":"7","author":"Fiegl","year":"2001","journal-title":"Breast J."},{"key":"ref_2","first-page":"716","article-title":"Ulcerative locally advanced breast cancer: The efficacy of combined anthracycline-based and hormonal therapy","volume":"25","author":"Kakagia","year":"2004","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_3","unstructured":"(2026, May 12). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer (Version [3.2026]), Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/breast.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1016\/j.annonc.2021.09.019","article-title":"ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer","volume":"32","author":"Gennari","year":"2021","journal-title":"Ann. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1159\/000545018","article-title":"AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2025","volume":"20","author":"Thill","year":"2025","journal-title":"Breast Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1159\/000550147","article-title":"ABC8 Consensus: Assessment by a German Group of Experts","volume":"21","author":"Ditsch","year":"2026","journal-title":"Breast Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1056\/NEJMoa1607303","article-title":"Palbociclib and Letrozole in Advanced Breast Cancer","volume":"375","author":"Finn","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Fejer, A., Atbaei, M.A., Zand, A., Varjas, T., and Zsuzsanna Kiss, Z. (2026). Psychometric Properties of the Breast Cancer Awareness Measure (Breast-CAM): A Systematic Review and Meta-Analysis. Cancers, 18.","DOI":"10.3390\/cancers18060956"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103870","DOI":"10.1016\/j.breast.2024.103870","article-title":"Therapeutic strategies for fungating and ulcerating breast cancers: A systematic review and narrative synthesis","volume":"79","author":"Zagardo","year":"2025","journal-title":"Breast"},{"key":"ref_10","first-page":"e103978","article-title":"Fungating Breast Carcinoma Complicated by Carbapenem-Resistant Pseudomonas aeruginosa Infection in a Patient With Severe Blood-Injection-Injury Phobia: A Case Report","volume":"18","author":"Mourad","year":"2026","journal-title":"Cureus"},{"key":"ref_11","first-page":"e72962","article-title":"The Use of Floseal Hemostatic Agent for Local Bleeding Control in Fungating Breast Cancer: A Case Report and Review of Literature","volume":"16","author":"Abid","year":"2024","journal-title":"Cureus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/s13691-025-00783-w","article-title":"A case of long-term relief from bleeding due to fungating breast cancer in an elderly patient after 8-Gy single-fraction radiation therapy","volume":"14","author":"Kokubo","year":"2025","journal-title":"Int. Cancer Conf. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"101842","DOI":"10.1016\/j.adro.2025.101842","article-title":"Adaptive Repeat Quad Shot Radiation Therapy for Uncontrolled Symptomatic Fungating or Skin-Infiltrating Primary and Regional Nodes in Patients with Metastatic Breast Cancer: Durable In-Field Tumor Control Without Interrupting Systemic Therapy","volume":"10","author":"Kil","year":"2025","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s13193-022-01602-x","article-title":"Fungating and Ulcerating Breast Cancer: Wound Closure Algorithm, Complications, and Survival Trends","volume":"14","author":"Abdallah","year":"2023","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_15","first-page":"e39","article-title":"Management and Reconstruction in the Breast Cancer Patient With a Fungating T4b Tumor","volume":"15","author":"Sood","year":"2015","journal-title":"Eplasty"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1744\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T14:25:24Z","timestamp":1780669524000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":15,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16111744"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16111744","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]}}}