case_images: PMC11089181_01
case_images: Computed tomography images and magnetic resonance images. The coronal image shows bilateral hydronephrosis and enlarged kidneys (A,E). The axial images show diffuse lesions in the renal parenchyma, with no obvious masses detected (B,C,F,G). The axial image shows retroperitoneal multiple exudation (D,H).
case_images: fmed-11-1353822-g001.jpg
case_images: PMC11089181_01_fmed-11-1353822-g001.jpg
case_images: fig1
case_images: Abdominal CT and magnetic resonance imaging (MRI) (Figure 1) revealed bilateral kidney swelling, dilation of the bilateral kidneys, renal calyces, and upper ureters, accompanied by multiple retroperitoneal and bilateral perirenal exudations, suggestive of retroperitoneal fibrosis.
case_images: 18F-FDG PET/CT images. The MIP demonstrated patchy metabolic elevation on both sides of the mammary glands, as well as increased volume in both kidneys, accompanied by a diffusely uneven elevated metabolic lesion (A). The bilateral dense breast tissue shows diffuse mild 18F-FDG uptake, with an SUVmax of approximately 4.7. There is a local thickening of the skin in both breasts, with an SUVmax of 2.3, more prominent on the right side (B). The transverse images show inhomogeneous 18F-FDG uptake in the bilaterally enlarged kidneys, with an SUVmax of approximately 8.2 (C). The transverse images show right perirenal fascia thickening with a significantly higher uptake of an SUVmax of approximately 3.3 (D). The sagittal images show the heterogeneous bone density elevation with radioactive distribution, SUVmax of approximately 2.9 (E,F).
case_images: fmed-11-1353822-g002.jpg
case_images: PMC11089181_01_fmed-11-1353822-g002.jpg
case_images: fig2
case_images: The anteroposterior 3-dimensional maximum intensity projection (MIP) image demonstrated patchy metabolic elevation on both sides of the mammary glands, along with diffusely uneven metabolic foci in both kidneys (Figure 2A). BBC was considered (Figure 2B). Enlargement of both kidneys with various degrees of 18F-FDG uptake is found, with an SUVmax at approximately 8.2 (Figure 2C). A patchy soft tissue density lesion is visible around the renal fascia and adjacent to the abdominal aorta, with mild 18F-FDG uptake, and the SUVmax is approximately 3.3 (Figure 2D). Additionally, inhomogeneous hyperintensities in bone mineral density were identified in the cones (Figures 2E,F), prompting suspicion of potential bone metastasis.
case_images: Histologic and immunohistochemical features of breast cancer. (A) Hematoxylin-eosin (HE) staining (x400). In immunohistochemical staining, the tumor cells were positive for ER (B) and GATA3 (C). Moreover, 15% of them were positive for Ki-67 (D) [magnification (B-D) x 200].
case_images: fmed-11-1353822-g003.jpg
case_images: PMC11089181_01_fmed-11-1353822-g003.jpg
case_images: fig3
case_images: Pathological examination (Figure 3) revealed grade II invasive lobular carcinoma with ER 90%, PgR 50%, P40-, E-cadherin-, P120++, GATA (3+), Ki67 15%, HER2-, and PD-L1- in both breasts.