Transcatheter arterial embolization enabling curative surgery for bleeding locally advanced breast cancer: a case report.

Abstract

Introduction and importance: Locally advanced breast cancer (LABC), defined as stage IIIB or IIIC disease without distant metastasis, is generally managed with systemic therapy as the initial treatment. However, uncontrolled bleeding from fungating tumors may interrupt treatment continuity and render definitive surgery unfeasible. Although endovascular therapy is occasionally used as an emergency hemostatic measure, its role in enabling curative surgery remains insufficiently documented. We report a case of LABC in which transcatheter arterial embolization (TAE) successfully controlled tumor bleeding and enabled subsequent definitive resection.

Presentation of case: A 66-year-old woman with untreated breast cancer presented with massive hemorrhage from a rapidly enlarging fungating tumor, resulting in transient loss of consciousness. Contrast-enhanced computed tomography revealed a 10-cm left breast mass with axillary and supraclavicular lymphadenopathy without distant metastasis (T4bN3cM0, stage IIIC). Persistent bleeding initially precluded definitive oncologic treatment. Endovascular embolization of the internal mammary and lateral thoracic arteries was performed on the second hospital day, achieving immediate and sustained hemostasis.

Clinical discussion: Hemorrhage control enabled uninterrupted radiotherapy and endocrine therapy, leading to marked tumor regression. Subsequent total mastectomy with axillary dissection was performed without skin grafting, and pathology demonstrated minimal residual disease with no nodal metastasis.

Conclusion: TAE may provide rapid and durable hemorrhage control, thereby allowing uninterrupted multimodal therapy and ultimately enabling curative surgery in selected patients with LABC.