Superior vena cava (SVC) syndrome, an oncologic emergency, necessitates prompt and aggressive treatment. In oncology, the most common cause is lung cancer followed by lymphoma and solid organ metastasis. A 56-year-old female presented to the oncology clinic with a one-month history of facial edema and dyspnea. Three years ago, she was diagnosed with hormone receptor(HR)-positive and human epidermal growth factor 2(HER2)-negative stage IIIB ductal carcinoma. She underwent radical mastectomy of the right breast and adjuvant chemotherapy (doxorubicin, cyclophosphamide and docetaxel), radiation and subsequent endocrine therapy with letrozole. Two years into follow-up, an immovable solid mass measuring 3 cm x 3 cm x 2 cm was noted at the right clavicular area with no other palpable breast mases. She gradually presented with dyspnea, facial swelling and right upper extremity edema. Initial chest X-ray showed consolidation versus mass at the right upper lung field. Computed tomographic scan done showed a soft tissue mass in the right superior mediastinum measuring 4.9 x 4.1 x 4.8 cm intimately adjacent and extending into the SVC with secondary luminal narrowing. Bone scan done showed an osteoblastic focus at the sternomanubrium area consistent with possible metastasis. A 2D-echocardiogram done to rule out cardiac involvement of the heart was unremarkable. Sputum acid-fast bacillus smear as well as lactate dehydrogenase and alpha fetoprotein were likewise negative.
Patient was then admitted for progressive dyspnea, facial and right upper extremity edema. A total of 232 mL of pleural effusion was drained and biopsy of the clavicular mass was performed showing expression of GATA3, mammoglobin, as well as estrogen and progesterone receptors consistent with ductal carcinoma. HER2 was also negatively expressed, consistent with the initial tumor profile. The managing team decided to proceed with emergent chemotherapy and managed the case as SVC syndrome. After 8 cycles of paclitaxel and carboplatin, a dramatic improvement in the symptoms was noted. Patient is currently ongoing hormonal treatment with tamoxifen and exhibits good quality of life with no disease recurrence.