case_images: PMC10794072_01
case_images: A photograph of the patient's left breast revealing breast swelling, peau d'orange skin changes, and nipple retraction.
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case_images: fig1
case_images: Her left breast became increasingly more edematous, and she began to experience skin changes, which started to rapidly progress in February 2023 (Figure 1).
case_images: Mammographic comparative analysis of the patient's right and left breasts, with the involved left breast showing scattered fibroglandular densities (arrow) with diffuse increased densities of the left breast with skin thickening. A left breast BI-RADS category 4 score was given, with suspicion for inflammatory carcinoma. The right breast was scored BI-RADS category 1.
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case_images: fig2
case_images: The right breast was scored as BI-RADS category 1, negative for cancer with calcifications (Figure 2).
case_images: Ultrasound analysis of the patient's left breast which revealed a BI-RADS category 4 irregular, indistinct, and hypoechoic mass measuring 2.0 x 1.5 x 1.2 cm at the 1 : 00 position, 4 cm from the nipple with the left breast.
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case_images: fig3
case_images: A BI-RADS category 4 score was given:suspicious abnormality with biopsy recommended (Figure 3).
case_images: Comparative CT analysis of the patient's abdomen/pelvis before surgery, showing the ovarian mass (a, arrow) and in May 2023, where no abdominal/pelvic recurrence is identified.
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case_images: fig4
case_images: Interestingly, computed tomographic, X-ray, and magnetic resonance imaging analyses of the patient's chest, brain and head, and pelvis from November 2022 to late May 2023 revealed no pelvic recurrence and no other identifiable metastatic disease besides the patient's left breast (Figure 4). Immunohistochemical analysis for AE1/AE3, PAX8, E-cadherin, and GATA-3 showed the same pattern, with immunopositivity seen with the first three stains, accompanied by immunonegativity for GATA-3 (Figure 4).
case_images: Hematoxylin and eosin stains (H&E) and immunohistochemical analyses of the ovarian serous adenocarcinoma presenting as inflammatory breast cancer. (A) Low-power H&E stain of the left breast, including skin and underlying connective tissue. (B) High-power H&E stain of the left breast dermis showing scattered pleomorphic malignant cells. (C) Very high-power H&E stain of the left breast showing a focus of lymphovascular invasion (arrow). (D) The AE1/AE3 cytokeratin satin reveals infiltrating carcinoma cells within the left breast. PAX8 and GATA-3 immunostains of the left breast showing strong PAX8 nuclear immunoreactivity (E) and GATA-3 nuclear immunonegativity (F), consistent with an ovarian primary. (G-I) The metastatic ovarian tumor cells were also immunonegative for HER2/neu, ER, and PR, also consistent with an ovarian primary (red arrows).
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case_images: fig5
case_images: They were immunonegative for GATA-3, HER2/neu, and the estrogen and progesterone receptors (Figure 5).