A 53-year-old female with a 2-month history of cough and dyspnea nad a PET-CT showing multiple lytic and blastic lesions in the axial skeleton. At admission, CBC was largely unremarkable while serum CA15-3 was 122.8U/ML, CEA:8.8ng/mL, with elevated LDH of 1096UI/L and a serum calcium of 9.4mg/dL.

Bone marrow aspirate and biopsy was perform with report of the biopsy adenocarcinoma of the breast: The immunoprofile was GATA3+, GCDFP-15+, Mammoglobin+, P16+ consistent with a breasy primary. Additional HER2 was strongly positive at 3+.