case_images: PMC10945424_01
case_images: The clinical presentation is multiple red papules scattered on the back (A-C). After 3 months of endocrine therapy, the back rash disappeared (D).
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case_images: F1
case_images: Physical examination revealed multiple scattered red papules on the back, protruding from the surface of the skin with clear boundaries and no itching (Figures 1A-D). After 3 months of treatment, the patient's rash disappeared (Figure 1D), and the breast and stomach lesions were stable, and the patient is still receiving treatment.
case_images: Histopathological HE and immunohistochemistry of patient's skin biopsy. Original magnification x 20: (A) HE; (B) positivity for GATA3; Original magnification x 400: (C) negative for E-cadherin; (D) positivity for GCDFP15.
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case_images: F2
case_images: CK7, GATA-3, GCDFP15 and KI67, as well as negative staining of CK20 and E-cadherin (Figure 2, The image shows only part of the results). Combined with the above results, breast cancer metastasis was considered.
case_images: Imaging pictures of the patient at admission. (A) breast ultrasound; (B) lymph node ultrasound.
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case_images: F3
case_images: Breast imaging reporting and data system (BI-RADS) category 6 (Figure 3A). Enlarged lymph nodes can be seen in the left axilla, the largest being 0.8 cm x 0.4 cm, with full shape, clear boundaries, thickened cortex, clear lymph nodes, and no obvious blood flow signal in lymph nodes (Figure 3B).
case_images: Pathological HE and immunohistochemistry of breast tissue biopsy of the patient. (A) HE x 20; (B) HEx40; Original magnification x 20: (C) strong positivity for the estrogen receptor (ER); (D) strong positivity for the progesterone receptor (PR); (E) negative for E-cadherin; (F) P120 was positive in the cytoplasm.
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case_images: F4
case_images: The pathological findings of the left breast hypoechoic area and left axillary lymph node after biopsy showed that the immunohistochemistry of the left breast hypoechoic area was strong positive for ER (90%) and PR (80%), and negative for human epidermal growth factor receptor 2 (HER2) and E-cadherin, P120 was positive in the cytoplasm, and the positive rate of Ki67 was about 30% (Figure 4).
case_images: Gastric endoscopy and CT images of the patient. (A) Abdominal CT shows gastric wall thickening,the thickest part of which was about 2.3 cm in diameter, involving the whole circumference of the lumen, with a length of about 5 cm; (B) Endoscopy prompts chronic superficial atrophic gastritis.
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case_images: F5
case_images: Abdominal enhanced computed tomography (CT) (Figure 5A) showed poor gastric filling, thickening of gastric wall, and mild to moderate enhancement on enhanced scans. Chronic superficial atrophic gastritis is considered (Figure 5B).
case_images: Pathological HE and immunohistochemistry of gastric tissue biopsy of the patient. Original magnification x 20: (A) HE; (B) positivity for GATA3; Original magnification x 400: (C) negative for E-cadherin; (D) positivity for GCDFP15.
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case_images: F6
case_images: Immunohistochemistry showed strong positive for ER (90%) and PR (80%), positive for CK7, KI67, GCDFP15 and GATA3, and negative for CK20 and E-cadherin, which was consistent with invasive lobular breast carcinoma metastasis (Figure 6, The image shows only part of the results).
case_images: (A) Gastroscopic manifestations after treatment. (B) Pathological HE of gastric tissue biopsy after treatment. HE x 20.
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case_images: F7
case_images: Three biopsies were taken at the lesion site of the gastric antrum, with soft texture (Figure 7A). Pathological findings suggest chronic inflammation of mucosal tissue with mild intestinal metaplasia of glandular epithelium (Figure 7B).
case_images: The timeline diagram of patient diagnosis and treatment process.
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case_images: F8
case_images: The entire diagnosis and treatment process of the patient is shown in Figure 8.