case_images: PMC10917954_01
case_images: Appearance and clinical sign at initial diagnosis and after 2 cycles of treatment. (A,B) Image of the right chest mass from side (black arrow) and frontal (tumor lesions outlined with black dashed lines) at the initial diagnosis. (C) The ultrasound image showed enlarged right axillary node (3.54*1.05 cm) with disappearance of the normal lymph node structure (shown by the yellow arrow). (D) Changes in the right chest mass appearance after 2 cycles of treatment, compared with initial diagnosis (black dashed lines).
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case_images: F1
case_images: Upon physical examination, a breast mass exhibiting a concave alteration and surface hemorrhaging was observed, measuring approximately 15*10 cm (Figures 1A, B). The ultrasound examination of the right axillary lymph nodes revealed the presence of multiple hypoechoic nodules with indistinct boundaries and absence of lymphatic structure ( Figure 1C).
case_images: Image of pathological sections of tumor puncture. (A) H&E image of the pathological section. The yellow dashed line shows the tumor cancer foci, and the tumor cells grow in a nest, with obvious cell specificity, and nuclear division. Significant cell keratosis is seen at the positions indicated by the red arrows. Immunohistochemical staining images of for ER (B), PR (C), HER 2 (D), CK7 (E), P63 (F), P120 (G), E-cadherin (H), P53 (I), Ki-67 (J). Scale Bar = 50 mum.
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case_images: F2
case_images: Subsequently, a biopsy of the breast mass was performed and H&E pathological image showed the tumor cells grow in a nest, with obvious cell specificity, nuclear division and significant cell keratosis, indicated the presence of invasive carcinoma with squamous differentiation (Figures 2A). Immunohistochemistry further revealed negative expression of ER and PR, strongly positive expression of HER2, positive expression of CK7, partial positive expression of P63, membrane positive expression of P120, negative expression of E-cadherin, wild type expression of P53, and approximately 30% positive expression of Ki-67 (Figures 2B-J).
case_images: CT and PET-CT images of the patient. (A,B) CT images of the lung at the initial diagnosis showed multiple lung metastasis (shown by the red arrow). (C) Overview of the whole-body PET-CT image. (D-G) PET-CT image showed an increased uptake of fluorodeoxyglucose (FDG) in right chest wall soft tissue, right axillary lymph nodes, and multiple parts of both lungs (shown by the red arrow). (H,I) CT images of the lung after 2 cycles of treatment showed decreased lung metastasis (shown by the red arrow compared with initial diagnosis).
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case_images: F3
case_images: A lung computed tomography (CT) scan revealed the presence of multiple nodules with irregular morphology and burr change in both lungs, suggesting the possibility of metastatic tumor (Figures 3A, B). A positron emission tomography-computed tomography (PET-CT) examination demonstrated an increased uptake of fluorodeoxyglucose (FDG) in right chest wall soft tissue, right axillary lymph nodes, and multiple parts of both lungs, considering lymph node and multiple lung metastasis (Figures 3C-G). August 2022 (Figures 3H, I), which was classified as a partial response. At the same time, the evaluation of the patient's physical condition showed that she still had a good mental state and stable vital signs, and no significant side reactions were described.
case_images: Brain MRI images and the overall treatment timeline. (A) Brain MRI images at May 2023 showed right frontal lobe nodule accompanied by edema in the adjacent brain tissue (lesions outlined with red dashed lines). (B) Brain MRI images after SBRT and combined therapy including T-DM1 combined with Tucatinib. (C) Changes in the right chest mass appearance at October 2023. (D) Treatment timeline from June 2022 to November 2023.
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case_images: F4
case_images: However, brain MRI revealed the presence of a right frontal lobe nodule accompanied by edema in the adjacent brain tissue, and metastasis was considered (Figures 4A). Simultaneously, the patient's treatment regimen was modified to include the antibody drug conjugate (ADC) T-DM1 and the tyrosine kinase inhibitor (TKI) Tucatinib, starting from 18 August 2023. Subsequent brain MRI conducted on 26 September 2023, revealed a significant reduction in the size of the brain metastasis compared to previous scans (Figures 4B). The patient is presently undergoing ongoing treatment, as depicted in Figures 4C, D.