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case_images: The upper portion of the right breast, with the mass, is out of shape. The edges characterized by spicule signs and architectural distortion, blood vessels thickened, and adjacent posterior gaps disappeared. There were no abnormal axillary lymph nodes. (a) MLO; (b) CC.
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case_images: The mammography suggested the lump was malignant tumor (Figure 1).
case_images: The upper quadrant back zone of the right breast showed a class of circular abnormal signals, with multiple "burr signs" at the boundaries, lesion size 2.4x2.7x2.7cm, Cooper ligament has been pulled and displacement, no apparent skin thickening, the unclear demarcation between the lesion and the pectoralis major muscle fascia, and no significantly enlarged lymph nodes in the bilateral axilla. (a): T2 sequence; (b): enhancement.
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case_images: The MRI also suggested a malignant tumor (Figure 2).
case_images: Preoperative puncture confirmed: Invasive ductal carcinoma of the right breast. (a) HE stains; (b) Immunohistochemistry of the estrogen receptor (ER) suggested a positive rate of 80%; (c) Immunohistochemistry of the progesterone receptor (PR) suggested a positive rate of 5%; (d) Immunohistochemistry of the human epidermal growth factor receptor-2 (Her-2) were indicated as negative; (e) Immunohistochemistry of Ki-67 showed a positive rate of 10%.
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case_images: After core needle biopsy the histopathological examination indicated a invasive ductal carcinoma and the estrogen receptor was 80% positive, the progesterone receptor was 3% positive, Her-2 was negative, and KI-67 was 10% positive (Figure 3).
case_images: Frozen during surgery confirmed: No tumor metastasis in the axillary sentinel lymph nodes.
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case_images: We performed radical mastectomy and axillary sentinel lymph nodes biopsy, while the result of intraoperative freezing suggested no cancer metastasis in the axillary sentinel lymph nodes (Figure 4); at the same time, we found a malignant tumor on the part of the surface of the pectoralis major muscle intraoperatively, and a few of hard swollen axillary lymph nodes.
case_images: Postoperative tumor histological examination: invasive ductal carcinoma, NST, 2.6x2.2x2.0cm, nerve invasion, found 14 axillary lymph nodes, no tumor metastasis. (a) HE stains; (b) Immunohistochemistry of the estrogen receptor (ER) suggested a positive rate of 90%; (c) Immunohistochemistry of the progesterone receptor (PR) suggested a positive rate of 9%; (d) Immunohistochemistry of the human epidermal growth factor receptor-2 (Her-2) were indicated as negative; (e) Immunohistochemistry of Ki-67 showed a positive rate of 40%.
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case_images: II, the estrogen receptor was 90% positive, the progesterone receptor was 90% positive, Her-2 was negative, and KI-67 was 40% positive (Figure 5).
case_images: Recurrence of the chest wall: A hypoechoic nodule, 10.9x5.4mm.
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case_images: Color Doppler ultrasound imaging of the node suggested that the subcutaneous solid nodule could be a recurrence of breast cancer (Figure 6).
case_images: Breast MRI: The right chest wall annular enhancing nodule outside the right breast surgery area was approximately 1.3cm in diameter.
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case_images: The MRI suggested that there was a annular enhancing nodule outside the right breast surgery area, which was almost 1.3cm (Figure 7).
case_images: Chest wall biopsy suggested: Malignant tumor, derived from breast cancer. (a) HE stain; (b) Immunohistochemistry of the estrogen receptor (ER) suggested a positive rate of 80%; (c) Immunohistochemistry of the progesterone receptor (PR) suggested a positive rate of 50%; (d) Immunohistochemistry of the human epidermal growth factor receptor-2 (Her-2) were indicated as negative; (e) Immunohistochemistry of Ki-67 showed a positive rate of 50%.
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case_images: Part of chest wall tissue was harvested for biopsy, and then the pathological findings suggested it was a malignant epithelial tumor, the estrogen receptor was 80% positive, the progesterone receptor was 50% positive, Her-2 was negative, and Ki-67 was 50% positive (Figure 8), and been confirmed it came from breast cancer.
case_images: The patient was found with a scalp mass in May 2022.
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case_images: In the 32nd month after surgery, a mass was found in her scalp (Figure 9).
case_images: (a) Systemic bone imaging (b) Upper abdominal magnetic resonance (c) Cranial magnetic resonance. Suspected metastases were suggested at multiple sites.
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case_images: In order to excluded other site metastasis, she underwent systemic bone imaging, skull and upper abdominal magnetic resonance examination, and the results suggested that there were multiple bone metabolic active lesions in the skull, left clavicle, left scapula, left iliac bone, and right sub femoral segment, tubercle of abnormal signals in the right cerebellar hemisphere, the left adrenal gland was significantly thickened and there was a round occupation of the right lower kidney, which could be considered metastasis (Figure 10).