case_images: PMC5439541_01
case_images: PMC5439541_02
case_images: Axial cut of CT-chest demonstrates a well-circumscribed soft tissue density (*) in the left breast measuring 3.1x3.7 cm.. Abbreviation: CT, computed tomography.
case_images: bctt-9-337Fig1.jpg
case_images: PMC5439541_02_bctt-9-337Fig1.jpg
case_images: f1-bctt-9-337
case_images: His past medical history was significant for dyslipidemia, hypertension, noninsulin-dependent diabetes, ankylosing spondylitis, and a traumatic neck injury requiring anterior cervical discectomy and plating with upper extremity weakness sequelae. computed tomography (CT) imaging revealed a well-circumscribed density of the left breast measuring 3.1x3.7 cm consistent with asymmetrical gynecomastia vs carcinoma, as seen in Figure 1.
case_images: (A) Photomicrographs of tissue specimens from left breast mass stained with hematoxylin and eosin at medium magnification demonstrates discohesive neoplastic cells in a single-file infiltrating pattern with little or no evidence of cellular and nuclear pleomorphism. Immunohistochemical stained slides at medium magnification shows (B) positive expression of lesional cells to cytokeratin (CK) antibodies with (C) coexpression of estrogen receptor (ER) and (D) progesterone receptor (PR) antibodies.
case_images: bctt-9-337Fig2.jpg
case_images: PMC5439541_02_bctt-9-337Fig2.jpg
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case_images: Histopathological examination of the core biopsy revealed the presence of diffusely infiltrating neoplastic cells with small nuclei and no significant pleomorphism or evidence of tubule formation (Figure 2A). HMWK (Figure 2B), and with focal expression of GCDFP. Hormone receptor immunostains showed overexpression of the lesional cells to ER (Figure 2C) and PR (Figure 2D) and negative for ErbB2.
case_images: (A) Photomicrographs of thoracentesis sample at medium magnification from right pleural effusion shows the presence of a dual population of cells: mesothelial and malignant cells. The malignant cell population are highlighted with positive staining with BER-EP4 (B) and negative to calretinin, (C) which is expressed in the surrounding nonneoplastic mesothelial cells, supporting the presence of metastatic disease.
case_images: bctt-9-337Fig3.jpg
case_images: PMC5439541_02_bctt-9-337Fig3.jpg
case_images: f3-bctt-9-337
case_images: Thoracentesis sampling of right pleural fluid demonstrated a dual population of cells (Figure 3A) with the malignant cells expressing BerEP4 (Figure 3B) and negative to staining with calretinin, which was strongly expressed in the background mesothelial cells (Figure 3C), consistent with metastatic breast carcinoma.