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case_images: Clinical image of Case 1:G.S. The figure illustrates approximately a 10 cm ulcerated, with active bleeding, tumor in the central quadrant of the left breast; adjacently, skin invasion with retraction can be observed.
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case_images: There was no family history of cancer, no allergies, and no occupational exposure to carcinogens (Figure 1).
case_images: Immunohistochemistry of Case 1:G.S. (a) HE x 400: Invasive breast carcinoma NST (invasive ductal carcinoma NOS)-G3: sheets of large, pleomorphic tumor cells with frequent mitotic figures; (b) ER x 200: Estrogen receptor positive with strong nuclear expression in tumoral cells; (c) PR x 200. Progesterone receptor positive with strong nuclear expression in tumoral cells; (d) HER2 x 400: negative (no staining observed in tumor cells); (e) Ki67 x 200: Estimated Ki67 labeling index is ~70%.
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case_images: The biopsy confirmed a pathological diagnosis of invasive ductal carcinoma, no special type (NST), poorly differentiated (G3), estrogen receptor (ER) positive, progesterone receptor (PgR) positive, and HER2-negative, immunohistochemistry (IHC) score = 0, with a Ki-67 proliferation index of 70% (Figure 2).
case_images: The clinical improvement of Case 1:G.S., after treatment completion, over a period of 12 months. (a) April 2023, two months post-therapy, the bleeding and ulceration show signs of healing, with no active bleeding and ulceration and reduced inflammation. (b) July 2023, a healing tissue begins to form, with significantly reduced inflammation and retracted skin. (c) August 2023, the healing process continued to develop, with the initial lesion becoming almost entirely covered by the healing tissue. (d) October 2023, the initial lesion is resolved, with only regions of healthy cicatricial tissue and skin remodeling due to the initial structural changes made by the tumor. (e) January 2024, the cicatricial tissue reduced its circumference, with healthy skin color and no signs of inflammation; post-radiation dermatitis skin can be observed across the region of RT.
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case_images: Moreover, healing tissue started growing in the perimeter of the initial lesion, with improved skin elasticity, less retraction, and less inflammation, finally resulting in healthy cicatricial tissues (Figure 3).
case_images: Clinical image of Case 2:T.T., June 2021. The figure illustrates approximately a 6 cm ulcerated tumor with irregular margins, skin changes, and involvement of the areola.
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case_images: She was a smoker, obese, with a body mass index (BMI) of 36, on anti-hypertensive treatment, and postmenopausal; additionally, there was no family history of cancer, no allergies, and no occupational exposure to carcinogens (Figure 4).
case_images: Immunohistochemistry of Case 2:T.T. (a) HE x 200: Mucinous breast carcinoma: nests of tumor cells floating in pools of extracellular mucin; (b) ER x 200: Estrogen receptor positive with strong nuclear expression in tumoral cells; (c) PR x 200: Progesterone receptor positive with variable nuclear expression in tumoral cells; (d) HER2 x 400: weak to moderate complete membrane staining observed in >10% of invasive tumor cells (score 2+/equivocal); (e) Ki67 x 200: Estimated Ki67 labeling index is 5%.
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case_images: Following IHC, the tumor expressed ER+, PR in 30% of the tumoral cells, and IHC = 2, with a Ki-67 proliferation index of 5% (Figure 5).
case_images: The clinical improvement of Case 2:T.T., after treatment completion, over a period of 12 months. (a) August 2021, one month after the treatment was initiated. (b) October 2021, the ulcerated tissue starts to reduce its dimensions, and the healing crusts begin to appear. (c) November 2021, a more intense cicatricial tissue is forming, while the initial lesion starts to diminish. (d) July 2022 and (e) December 2022, large post-radiotherapy changes and scarring, but no signs of secondary signs of breast cancer were identified.
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case_images: The initial lesion reduced its diameter, while the process of neoformation of a healthy tissue began (Figure 6).