case_images: PMC11800317_01
case_images: Multiple hemorrhagic nodulo-ulcerative lesions present over extensor aspect of the right arm
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case_images: PMC11800317_01_cureus-0017-00000077064-i01.jpg
case_images: FIG1
case_images: On local examination, multiple erythematous and hemorrhagic papulonodular lesions were present over the extensor aspect of the right arm, extending to include an area of 8 x 6 cm (Figure 1).
case_images: MRI showing an ill-defined lesion in lateral aspect of midarm in cutaneous and subcutaneous plane (arrow). MRI, Magnetic resonance imaging
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case_images: FIG2
case_images: T2, proton density fat saturation (PDFS), gradient echo (GRE), and short tau inversion recovery (STIR) sequences, which showed an ill-defined lesion in the cutaneous and subcutaneous plane of the midarm on the lateral aspect (Figure 2), with a maximum thickness of 1.2 cm and involving an area of 7 x 8 cm, with no restriction of diffusion, while inhomogeneous enhancement was noted on contrast study. The marrow signal of the humerus and neurovascular bundles were within normal limits. The Doppler study of the vessels in the arm was normal.
case_images: Histopathology slide description. (A) Low-power magnification shows skin ulceration (arrowhead) and subepithelial pleomorphic epithelial (ductal) cells, seen in variable sheets (asterisk) and groups, invading the subepithelial stromal tissue. No dysplasia in the overlying epithelium is noted. (B) High-power image shows pleomorphic ductal epithelial cells with marked pleomorphism, prominent nuclei, and abundant eosinophilic cytoplasm (arrow).
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case_images: PMC11800317_01_cureus-0017-00000077064-i03.jpg
case_images: FIG3
case_images: Biopsy of the right breast lump. (A) Low magnification (100x) showing infiltrating islands and cords (hollow arrowhead) of neoplastic cells infiltrating into the stroma (hematoxylin and eosin stain, 10x objective, 10x optics). (B) High magnification (400x) showing no tubule formation and moderately pleomorphic cells (hollow arrowhead) with high mitosis, reported as grade 3 according to the Nottingham histological score (hematoxylin and eosin stain, 40x objective, 10x optics).
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case_images: FIG4
case_images: A core biopsy from the right breast lump (Figure 4) revealed metaplastic carcinoma (a combination of invasive ductal carcinoma (50%) and keratinizing SCC (50%)).
case_images: PET scan showing FDG avid contiguous and discrete enhancing soft tissue lesions in the right breast (arrow). PET, Positron emission tomography; FDG, Fluorodeoxyglucose
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case_images: PMC11800317_01_cureus-0017-00000077064-i05.jpg
case_images: FIG5
case_images: Cutaneous metastatic lesions in arm disappeared after chemotherapy resulting in scarred plaque
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case_images: FIG6
case_images: Her papulo-nodular lesions in her arm have disappeared, resulting in a scarred plaque (Figure 6).