case_images: PMC4392555_01
case_images: 46-year-old female with history of neurofibromatosis Type 1 presented with left breast mass diagnosed as metaplastic breast carcinoma. Mediolateral (a) oblique and (b) craniocaudal views of left breast mammogram demonstrate a large, relatively circumscribed mass (arrows) adjacent to a dot-shaped radiopaque skin marker to indicate the palpable area in the central left breast. It measured approximately 10 x 10 x 9 cm. Circular-shaped radiopaque skin markers were placed to indicate the skin lesions (neurofibromas) which are consistent with patient's known neurofibromatosis.
case_images: JCIS-5-17-g002.jpg
case_images: PMC4392555_01_JCIS-5-17-g002.jpg
case_images: F1
case_images: Mammogram showed a large, centrally located left breast mass associated with microcalcifications measuring 10 x 10 x 9 cm [Figure 1].
case_images: 46-year-old female with history of neurofibromatosis Type 1 presented with left breast mass diagnosed as metaplastic breast carcinoma. Targeted breast ultrasound on the palpable area in the central left breast demonstrates a large heterogeneous mass with central necrosis (solid arrow) and peripheral irregular solid components (dashed arrow) with Doppler flow.
case_images: JCIS-5-17-g003.jpg
case_images: PMC4392555_01_JCIS-5-17-g003.jpg
case_images: F2
case_images: Ultrasound of the subareolar left breast showed a large circumscribed mass, with central necrosis and irregular peripheral solid components [Figure 2].
case_images: 46-year-old female with history of neurofibromatosis Type 1 presented with left breast mass diagnosed as metaplastic breast carcinoma. Ultrasound of the left axilla showed an enlarged axillary lymph node (arrow) with eccentric thickened cortex.
case_images: JCIS-5-17-g004.jpg
case_images: PMC4392555_01_JCIS-5-17-g004.jpg
case_images: F3
case_images: An enlarged left axillary lymph node was also identified, measuring about 1.6 x 0.8 x 1.4 cm [Figure 3].
case_images: 46-year-old female with history of neurofibromatosis Type 1 presented with left breast mass diagnosed as metaplastic breast carcinoma. Microscopic examination of the core biopsy (hematoxylin and eosin stain, x200) reveals solid sheets of neoplastic cells with squamous differentiation (arrows), diagnostic of metaplastic breast carcinoma with keratinizing squamous histology.
case_images: JCIS-5-17-g005.jpg
case_images: PMC4392555_01_JCIS-5-17-g005.jpg
case_images: F4
case_images: Pathologic examination of the breast mass showed metaplastic breast carcinoma with keratinizing squamous histology [Figure 4].
case_images: 46-year-old female with history of neurofibromatosis Type 1 presented with left breast mass diagnosed as metaplastic breast carcinoma. Breast MRI with (a) T1-weighted, (b) short tau inversion recovery (STIR), and (c and d) subtraction post-contrast images demonstrate a large mass (long arrows) in the central left breast with low T1 (a), high T2 (b), and rim-like enhancement (c). Small enhancing nodules (neurofibromas) (short arrows) are also noted at the skin of the left breast, consistent with patient's known neurofibromatosis (d).
case_images: JCIS-5-17-g006.jpg
case_images: PMC4392555_01_JCIS-5-17-g006.jpg
case_images: F5
case_images: T1 and high T2 signals and nodular peripheral rim enhancement [Figure 5]. The small enhancing nodules (neurofibromas) on the skin were consistent with the patient's known neurofibromatosis [Figure 5].
case_images: 46-year-old female with history of neurofibromatosis Type 1 presented with left breast mass diagnosed as metaplastic breast carcinoma. Breast MRI status post chemotherapy with subtraction post-contrast image shows significantly decreased size and rim enhancement of the mass (arrow) in the left breast.
case_images: JCIS-5-17-g007.jpg
case_images: PMC4392555_01_JCIS-5-17-g007.jpg
case_images: F6
case_images: Breast MRI, performed after the patient completed 8 cycles of neoadjuvant chemotherapy, demonstrated significantly decreased tumor size, peripheral rim enhancement [Figure 6], and axillary lymphadenopathy.