case_images: PMC10134057_01
case_images: MMG, ultrasonography, and magnetic resonance images of the right breast. a MMG with a dense breast pattern showed neither tumors nor microcalcifications. b Ultrasonography showed focal hyper-echoes (arrows) and hypo-echoes (asterisks) without distinct tumor formation. c Magnetic resonance images showed multifocal lesions with persistent enhancement.
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case_images: F1
case_images: Although the patient noticed a right breast mass just before the cytoreductive surgery, MMG showed no abnormalities (Fig. 1a). Ultrasonography showed only admixture of patchy hypo- and hyper-echoes without distinct tumor margins (Fig. 1b). Magnetic resonance imaging (MRI) with contrast medium showed multiple enhanced lesions with persistent enhancement in the right breast (Fig. 1c).
case_images: Chest computed tomography (CT) and positron emission tomography (PET). a CT showed massive effusion in the right pleural cavity, neither with pulmonary nodules nor with pleural masses. b PET showed no avidity in the breasts.
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case_images: F2
case_images: Positron emission tomography (PET)/CT showed no fluorodeoxyglucose uptake in the breasts (Fig. 2a, b).
case_images: Pathological findings. a, b Although the largest lesion (arrowheads) are distributed from the bottom to the top of the mammary gland, small nodules (arrows) are located deep in the mammary gland. c Typical signet ring cell carcinomas (arrowheads) formed a cluster. d A large mucous lake (asterisk) was observed in the mammary gland. e D2-40 immunostaining showed lymphovascular invasion (arrows).
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case_images: F3
case_images: Pathological study of the resected breast showed triple-negative atypical cells similar to the biopsy specimen, mucous lake formation, predominant localization of the metastatic breast tumors deep in the mammary gland, and lymphovascular invasion (Fig. 3a-e).