A 55-year-old woman presented with a large breast ulceration, biopsy specimen–diagnosed invasive ductal carcinoma (IDC), grade 3, ER+/PR+/HER2−…Tumor sequencing showed an activating PIK3CA mutation H1047R and amplification of PIK3C2B. Disease progressed after 4 months of treatment with fulvestrant and palbociclib.