A 68 years old female, was diagnosed as a case of right breast cancer in 2013; grade II/III according to Bloom Richardson grading, Modify radical mastectomy (MRM) was done and the pathology report showed moderately differentiated invasive ductal carcinoma (IDC), stage T3N3M0. Immunohisrochemisty (IHC) findings revealed a tumor with Triple positive. Patient refused to treat by chemotherapy. Patient was given adjuvant trastuzumab (first dose 8 mg/kg, followed by 6 mg/kg every three weeks) for the period of one year (16) cycles after which she went on regular follow up. Exemestane tab for 5 years and radiotherapy (50 gray in 25 fractions) was applying on right breast. One year and half after diagnosed primary breast cancer, patient complained from severe diarrhea 8 times per day watery contents, vomiting and suffered from lower abdominal pain. PET scan for whole body in October 2014 was done; the results showed ascending colon is highly suspicious for malignancy and moderately hypermetabolic left adrenal mass. Subtotal colectomy surgery was done, the pathology report of biopsy revealed low grade malignant neuroendocrine neoplastic lesion stage of T3N1Mo. Physician prescribed octreotide acetate 20 mg I. M monthly due to neuroendocrine lesion. In January 2016, cancer recurrence in the same right breast, IHC revealed ER+, PR−, Her 2+, physician decided to change exemestane to fulvestrant 250 mg s. c for 6 cycles. Radiation therapy was applied 20 gray in 10 fractions on scar. In May 2016, CAP-CT scan result revealed two enlarged left axillary L.N and left soft tissue density adrenal mass (3.0 × 2.3).
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