case_images: PMC10663166_01
case_images: Ultrasound examination: (A) Small echoes of glands were observed deep in the right nipple. The larger lesion was located below the nipple and measured 4.4 cm x 4.4 cm x 1.4 cm. (B) Striped blood flow signals were observed in the region, while low echoes were observed in the shallow fat layer. (C and D) CT results showed a significant reduction of the tumor after treatment and the tumor was not obvious based on the mediastinum imaging results.
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case_images: The results of real-time shear wave elastography are shown in Figure 1.
case_images: (A) A small number of tumor tissue biopsies were obtained, with more tumor cells and reduced stroma observed by light microscopy. (B) The tumor cells were linear or trabecular, and some areas were monoline. (C) The local lesions included a mixture of cells. (D) The tumor cells were large with fine chromatin and multiple mitotic images. The cells also exhibited deep staining and were disproportionate in size, with no necrosis or bleeding being observed.
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case_images: As shown in Figures 2A-D, necrosis and bleeding were not observed.
case_images: All the stains were obtained using the MaxVision method (A) The CD30 results showing diffuse positive cells; (B) GrB outline of a positive cell membrane; (C) diffuse CD4 cell membrane staining; (D) MUM1 staining showing negative staining of the tumor cell nuclei; (E) ALK staining showing positive diffuse staining of the cells; (F) EMA staining showing weakly positive staining of the tumor cells.
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case_images: Bcl-2 (-), CD2l (-), CD23 (-), Bcl-6 (-), MUM1 (+), CD2 (-), CD4 (+), CD8 (-), CD5 (-), CD7 (-), TIA-1 (-), GrB (+), ALK (+), CD56 (-), EBER (-), and Ki-67 (70%+). Based on the above results the pathologic diagnosis was non-Hodgkin's anaplastic large cell lymphoma in the right breast, ALK-positive (Figures 3A-F).  
case_images: (A) BCOR_p.Q600X, DNMT3A_p.F609fs, NOTCH1_p.P2320fs, IDH2_p.R140Q gene mutations; (B) The tumor was not associated with IRF4/DUPS22 rearrangement.
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case_images: We also detected an additional signal for the nonrecombinant allele, suggesting a gain in the DUPS22 locus (Figure 4B). Chromosomal imbalance mapping using the Oncoscan  Chromosomal Imbalance Mapping platform revealed mutations in the following genes: BCOR_p.Q600X, DNMT3A_p.F609fs, NOTCH1_p.P2320fs, and IDH2_p.R140Q (Figure 4A).