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Pseudoprogression of metastatic breast cancer: case report A 62-year-old woman developed pseudoprogression of metastatic breast cancer during treatment with exemestane and palbociclib for metastatic breast cancer. The postmenopausal woman, who was diagnosed with breast cancer in her left breast, received modified radical mastectomy on 20 April 2017. Postoperatively, she was diagnosed with stage IIIC invasive ductal carcinoma of the left breast and received tamoxifen 20 mg/day after the initiation of radiotherapy until 12 March 2019. After 2 years of tamoxifen therapy, she had blunt pain in the left thoracic wall without signs of chest distress, palpitation, cough or dyspnoea. Colour ultrasound examinations of the breast, thoracic wall, axillary fossa and supraclavicular area showed solid space occupation on the lateral side of the left thoracic wall, which was close to the left axillary fossa and considered to be a metastasis. Additionally, the enlarged level IV lymph nodes in the right cervix were also considered to be a metastasis. PET-CT scanning revealed the following: multiple lymph node metastases in the mediastinum, bilateral portal and left lower lung, metastatic tumor in the basal segment of the right lower lobe, right scapula metastasis and sixth left rib metastasis accompanied by mass in the soft tissues with SUVmax of 17.2. The pathological examination of the biopsy of the mass in the left thoracic wall showed invasive carcinoma. In contrast, that of the level IV lymph node in the right cervix showed metastatic poor differentiated carcinoma. On 01 April 2019, she was initiated on oral palbociclib 125 mg/day on days 1–21 every 28 days and oral exemestane 25 mg/day. The pain in the left thoracic wall was significantly alleviated after 10 days of the treatment. A thoracic CT scan on 17 June 2019 (i.e. after three cycles of treatment) showed that the metastasis in the sixth left rib and the mass in the soft tissue progressed, which affected the fifth and sixth intercostal spaces; while the other metastases regressed. A repeat PET-CT scan showed that the mass in the soft tissues of the sixth left rib increased, and the SUVmax was 12.4; the other metastases regressed and the SUV values decreased. Physical examination did not reveal any enlargement of the superficial lymph nodes, and the mass in the left anterolateral thoracic wall was flattened without pain during pressing. Biopsy and pathological examination of the mass in the left thoracic wall showed adenocarcinoma invasion in the fibrous tissues of the left thoracic wall. Subsequently, the metastatic lesion at the sixth left rib shrunk and the clinical symptoms resolved, which was considered as a pseudoprogression. Due to improvement of clinical manifestations and pathological results, palbociclib and exemestane were continued until 31 July 2019. A repeat thoracic CT scan showed that the metastasis in the sixth left rib and mass in the soft tissue regressed, and bone reconstruction was observed. The tumour in the left thoracic wall regressed, and she