Lab reports and tumor-marker carbohydrate antigen 15-3 were within normal ideals (CA15-3 = 18.8 U/mL). the hepatic dysfunction, and we gradually reintroduced Trastuzumab and then Pertuzumab. In the meantime, the patient changed her way of life by increasing her usage of fresh fruits and vegetables and dietary fiber and reducing her intake of processed meat, dairy and sugar. As a result, the patient showed a significant improvement in her respiratory symptoms and liver checks in less than two weeks. Imaging reevaluation showed partial remission of liver metastases and pulmonary lymphangitic carcinomatosis. She underwent seven weeks of dual anti-HER2 blockade before relapsing cerebrally. Our results suggest that the sequential combination therapy with Trastuzumab, Pertuzumab and Paclitaxel offered with this study, associated with a healthy lifestyle, may be a good management for recurrent HER2-positive breast malignancy with pulmonary visceral problems and severe liver dysfunction. = 0.0049) [7]. About 10C15% of advanced breast cancer will develop visceral problems, which requires the use of probably the most rapidly effective therapy, which is not necessarily chemotherapy in all situations [8]. Pulmonary lymphangitic carcinomatosis is definitely a type of visceral problems frequently caused by breast malignancy (33%) [9]. The most common cause of acute liver failure is due to metastases of Ntrk1 solid tumors, usually from a breast malignancy (30%), which is definitely associated with a poor prognosis, with death occurring within a few days of the medical demonstration [10,11]. Generally, dealing with patients with breast malignancy and visceral problems remains challenging, usually because chemotherapy is definitely often not an option due to liver dysfunction and because the performance of existing anti-HER2-targeted therapies has not been evaluated in randomized AZ304 tests. In this regard, we report a case of advanced HER2-positive breast cancer whose liver recurrence and pulmonary lymphangitic carcinomatosis caused a life-threatening visceral problems. In this situation, chemotherapy with Paclitaxel was chosen with the progressive addition of dual anti-HER2 monoclonal blockade with Trastuzumab and Pertuzumab, which led to a significant response by rapidly improving the medical and biological guidelines, as well as the regression of liver metastases and lung lymphangitis. Particularly, correcting the patients way of life behavior during treatment further contributed to this response. 2. Case Statement In January 2019, a healthy 26-year-old female with a normal body weight (Height = 176 cm, AZ304 Excess weight = 74 kg, Body Mass Index = 23.89) and who was treated with Levetiracetam for tonic AZ304 seizures during pregnancy presented to a local clinic for any suspicious palpable mass in her remaining breast, which had been rapidly growing for the last 2 months. Her medical history was unremarkable: menarche at the age of 12 with regular menses, offers used combined oral contraceptive pills for 2 years, after which she experienced a vaginal birth at the age of 24 and breastfed for 12 months. There was no familial history of malignancy. The physical examination revealed a tumor in the outer quadrants of her remaining breast measuring 3/2.5 cm which was associated with erythema, pores and skin thickening, purulent mammary secretions and a mobile ipsilateral axillary adenopathy. Magnetic resonance imaging (MRI) exposed a lower outer quadrant tumor with extensions to the top outer quadrant (Number 1A,B). The biopsy and the following pathology exam of this ill-defined mass showed an invasive mammary carcinoma of no unique type, moderately differentiated (grade 2 of 3) with solid areas of in situ carcinoma of combined differentiation and considerable comedonecrosis (Number 2). Further immunohistochemistry showed the tumor indicated estrogen receptor (ER 70%), progesterone receptor (PR 20%), HER2 overexpression and a Ki-67 index of 40% (luminal subtype, HER2+). An ulterior whole-body computed tomography (CT) highlighted a suspicious 44/40/52 mm tumor in the caudate lobe of the liver and no additional metastases. For a better description of the lesion, an MRI was ordered which explained it like a focal hyperplasic nodule (HFN). Lab reports and tumor-marker carbohydrate antigen 15-3 were within normal ideals (CA15-3 = 18.8 U/mL). Correlated with these findings, the tumor was staged as T4bN1M0 stage IIIB according to the AJCC cancer-staging manual (eighth edition). Open in a separate window Number 1 (A) T2 weighted MRI of remaining breast demonstrating pores and skin thickening (3.2 mm) associated with hypersignal suggestive of edema. (B) T1 weighted MRI showing.