ArticleRadiology case reports2026
Symptomatic bone marrow involvement by metastatic occult HR+/HER2- breast cancer treated with ribociclib and letrozole: A case report.
Article in Radiology case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Visceral crisis (VC) occurs in less than about 15% of patients with de novo metastatic breast cancer (BC). We present a case of a 59-years-old woman who presented with history of bone pain, fatigue, dyspnea on exertion, and weight loss; on physical examination was found no breast nodules, enlarged lymph nodes, or enlarged viscera were palpable. Laboratory tests revealed hemoglobin 5.8 g/dl. PET CT scan showed multiple osteolytic lesions. A bone marrow biopsy was performed, which identified infiltration by an epithelial tumor lesion. Immunohistochemistry showed positivity for CK1/3, CK7, Gata-3, and estrogen and progesterone receptors. HER2 negative (0+). The diagnosis of de novo occult HR+/HER2- metastatic BC was made. Systemic treatment with ribociclib and letrozole was started; the patient experienced clinical improvement of the symptoms, weight gain and improvement in hemoglobin levels. VC in HR+/HER2- metastatic BC is a challenging situation from its definition to its management. In case of availability and quick access, a free CT regimen with CDK4/6i + endocrine therapy could be a option to consider in this patients. This also represents a challenge in terms of cost-effectiveness in the health systems of low-income countries.
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