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case_images: CT and 18F-PYLARIFY PSMA-PET images. (a) Noncontrast axial CT image displays a soft tissue mass along the right anterior chest wall abutting the pectoralis muscle (red arrow). Concordant abnormal PSMA radiotracer uptake (SUVmax 7.7) is depicted on axial (b) and sagittal fused PET and noncontrast CT (c) images, and on whole body maximum intensity projection image (d) (dashed red arrows). PSMA: prostate-specific membrane antigen; PET: positron emission tomography; CT: computed tomography.
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case_images: Another focus was noted along the right anterior chest wall (SUVmax 7.7) (Figure 1(a)-(d)), with no corresponding mass on physical examination of his breasts.
case_images: Right diagnostic mammogram including CC (a), MLO (b), XCCL (c), and XCCM; (d) views shows no significant masses, suspicious calcifications, or other abnormalities. CC: craniocaudal; MLO: mediolateral oblique; XCCL: exaggerated lateral CC; XCCM: exaggerated medial CC.
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case_images: A diagnostic bilateral mammogram revealed no significant mass, suspicious calcifications, or other abnormalities in the right breast (Figure 2(a)-(d)).
case_images: High-resolution real-time ultrasound of the right breast reveals a 1.5 x 2.1 x 1.8 cm irregular hypoechoic mass (red arrow) with spiculated margins and posterior shadowing (blue arrow) in the lower inner quadrant at 5 o'clock, located 3 cm from the nipple (a). The mass abuts the pectoralis musculature (dashed white arrow) (b). No internal vascularity was observed (c).
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case_images: However, targeted ultrasound of the right breast identified a 1.5 x 2.1 x 1.8 cm irregular hypoechoic mass with spiculated margins and posterior shadowing in the lower inner quadrant at the 5 o'clock posterior depth, approximately 3 cm from the nipple (Figure 3(a)). The mass abutted the pectoralis muscle (Figure 3(b)). No internal vascularity was observed (Figure 3(c)), and no axillary adenopathy was detected on ultrasound.
case_images: Hematoxylin and eosin staining of the biopsy specimen from the right breast mass depicts infiltrating aggregates of bland atypical cells with indistinct cell borders, eosinophilic, granular, abundant cytoplasm, and small nuclei (a). Immunohistochemical staining is positive for S-100 (b), SOX10 (c), and neuron-specific enolase (d). These findings support the diagnosis of granular cell tumors.
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case_images: Pathology from the ultrasound-guided core needle biopsy revealed dense, hyalinized stroma with infiltrating aggregates of bland atypical cells exhibiting a histiocytoid appearance, characterized by pink, granular cytoplasm and small nuclei (Figure 4(a)). Positive immunohistochemical (IHC) staining for S-100 (Figure 4(b)), SOX10 (Figure 4(c)), and neuron-specific enolase (NSE) (Figure 4(d)), along with negative pan-keratin staining supported the diagnosis of a granular cell tumor with benign characteristics.
case_images: Hematoxylin and eosin staining of the surgically excised breast mass specimen reveals tumor cells (blue arrow) characterized as large and polygonal, with eosinophilic, granular, abundant cytoplasm and centrally placed small and uniform nuclei. Perivascular involvement is observed (black arrow) (a). At higher magnification (x200), tumor cells with indistinct cell borders and forming syncytial groups are evident (blue arrow) (b). Additionally, microscopic evaluation shows tumor cells infiltrating skeletal muscle fibers (blue arrow) (c). Ki67 immunohistochemical staining indicates a low proliferative index, as tumor cell nuclei are negative for this marker (d).
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case_images: The final pathology report verified the diagnosis of a granular cell tumor (Figure 5(a) and (b)), with tumor cells infiltrating skeletal muscle fibers (Figure 5(c)). The low tumor proliferation index, combined with the absence of any morphological features suggesting malignancy, supported the benign nature of the disease (Figure 5(d)).