A 44 year old woman visited the hospital with complaint of the right breast tumor which she left for two years. She presented with a large mass of８．５cm in diameter with skin invasion, right axillar lymph nodes, multiple liver, and bone metastases. Core needle biopsy of the main tumor revealed an invasive ductal carcinoma（scirrhous carcinoma）with nuclear grade 2 with ER（＋）,PgR（＋）, HER2（－）. The patient was treated with hormone therapy for three and a half year.The extensive mediastinum lymph nodes metastasis and multiple lung metastasis and a new tumor in the right thyroid lobe were appeared. The liver metastasis also increased in size and number.The therapy switched to chemotherapy with paclitaxel. Although the reductive effect was appeared in the breast mass, lung metastasis and liver metastasis, the thyroid and mediastinal lymph node metastases increased in size aggressively. The cytology of needle biopsy specimen from the thyroid tumor was consistent with breast cancer metastasis. Histopathology of the biopsy specimens from the mediastinal lymph node and the liver metastases also consist with breast cancer metastases, but ER and PgR receptor status converted to negative in mediastinal lymph nodes
