case_images: PMC4378697_01
case_images: Subcutaneous mass invading left breast tissue (from previous admission).
case_images: CRIPU2015-136970.001.jpg
case_images: PMC4378697_01_CRIPU2015-136970.001.jpg
case_images: fig1
case_images: A 48-year-old African American male with a past medical history of infiltrating poorly differentiated left breast cancer (Figure 1) without lymph node involvement s/p modified radical mastectomy (MRM) along with axillary dissection 2 months earlier, COPD, bipolar disorder, and chronic smoking (20 pack-years) presented to the ER with progressive SOB for the past 2 months.
case_images: Left abdominal wall mass.
case_images: CRIPU2015-136970.002.jpg
case_images: PMC4378697_01_CRIPU2015-136970.002.jpg
case_images: fig2
case_images: There was a soft, nontender mobile mass in the periumbilical area which was 2 cm x 2 cm x 2 cm in size and appeared to be superficial on examination (Figure 2).
case_images: Chest X-ray: Rt upper lobe mass.
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case_images: fig3
case_images: The chest X-ray was reported as a deviation of the tracheal lumen to the left without obstruction and a right upper hemithorax mass (Figure 3).
case_images: Chest CT scan: Rt upper lobe density.
case_images: CRIPU2015-136970.004.jpg
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case_images: fig4
case_images: CT scan reported a large right upper lobe lung mass suspicious for malignancy, bullous emphysematous disease with pulmonary fibrosis, and mediastinal lymphadenopathy with small pleural effusion on the right (Figure 4).
case_images: Lung transbronchial biopsy specimen: poorly differentiated cluster of neoplastic cells with abundant cytoplasm with hyperchromatic nuclei. No gland or sheets of squamous cell formation.
case_images: CRIPU2015-136970.005.jpg
case_images: PMC4378697_01_CRIPU2015-136970.005.jpg
case_images: fig5
case_images: Biopsy results of the abdominal mass came back as high-grade malignant neoplasm with unclear etiology whereas the lung mass biopsy was reported as poorly differentiated non-small-cell lung cancer (Figures 5 and 6).
case_images: Abdominal wall biopsy specimen: poorly differentiated neoplastic cells with abundant cytoplasm with hyperchromatic nuclei. No gland or sheets of squamous cell formation.
case_images: CRIPU2015-136970.006.jpg
case_images: PMC4378697_01_CRIPU2015-136970.006.jpg
case_images: fig6
case_images: Biopsy results of the abdominal mass came back as high-grade malignant neoplasm with unclear etiology whereas the lung mass biopsy was reported as poorly differentiated non-small-cell lung cancer (Figures 5 and 6).
case_images: Left breast tissue (high power): poorly differentiated malignant cells, prominent nucleoli.
case_images: CRIPU2015-136970.007.jpg
case_images: PMC4378697_01_CRIPU2015-136970.007.jpg
case_images: fig7
case_images: The markers for breast and lung cancer (ER, PR, HER2, GCDPF-15, Mammaglobin, BCA225, GATA3, anti-TTF, CK7/20, and napsin A) were negative in all biopsies taken (breast (Figures 7 and 8), lung, and abdominal wall); however since the patient was male and a chronic smoker the diagnosis was made as Stage IV non-small-cell lung cancer with soft tissue metastases to both the abdominal wall and breast.
case_images: Infiltrating poorly differentiated carcinoma and surgical margin free of tumor. No ductal and no parenchymal tissues identified.
case_images: CRIPU2015-136970.008.jpg
case_images: PMC4378697_01_CRIPU2015-136970.008.jpg
case_images: fig8
case_images: The markers for breast and lung cancer (ER, PR, HER2, GCDPF-15, Mammaglobin, BCA225, GATA3, anti-TTF, CK7/20, and napsin A) were negative in all biopsies taken (breast (Figures 7 and 8), lung, and abdominal wall); however since the patient was male and a chronic smoker the diagnosis was made as Stage IV non-small-cell lung cancer with soft tissue metastases to both the abdominal wall and breast.
case_images: Head CT scan showing multiple brain metastases left breast tissue (low power field).
case_images: CRIPU2015-136970.009.jpg
case_images: PMC4378697_01_CRIPU2015-136970.009.jpg
case_images: fig9
case_images: Furthermore, head CT indicated multiple brain metastases (Figure 9).