case_images: PMC5660827_01
case_images: Picture of the left breast mass at diagnosis.
case_images: CRIOG2017-8963013.001.jpg
case_images: PMC5660827_01_CRIOG2017-8963013.001.jpg
case_images: fig1
case_images: A 57-year-old menopausal woman presented herself to our institution with a giant necrotic breast tumor and ipsilateral axillary lymphadenopathy (Figure 1).
case_images: Microscopic aspect of the primary tumor (a, b, c, d, e) and medullar metastasis (f). (a, b) Predominant benign PT component. The stroma is more cellular than a fibroadenoma. Stromal cellularity may be higher in the zone adjacent to epithelium without atypia and mitosis ((a) magnification x2, (b) magnification x200), (c, d) malignant PT component observed near the cutaneous ulceration (arrow). We observed a high stromal cellularity with atypia and mitosis without epithelial structure. There was no involvement of the tissue beneath the nipples nor lymphovascular or neural invasion. ((c) magnification x2, (d) magnification x200), (e, f) malignant primary (e), and medullar metastasis (f) PT at magnification x400. We observed a similar histologic pattern: a cellular stromal proliferation with atypia and mitosis (arrows). No epithelial components. All immunostainings were negative (estrogen receptor, progesterone receptor, pankeratin AE1, AE3, and PS100, desmin, CD34, caldesmon, and CD99) except for a focal staining with Smooth Muscle Actin antibody.
case_images: CRIOG2017-8963013.002.jpg
case_images: PMC5660827_01_CRIOG2017-8963013.002.jpg
case_images: fig2
case_images: The majority of the lesion was composed of a benign PT but a focal area presented a bulging high grade malignant PT with severity criteria: infiltrative borders, high mitotic count, marked stromal overgrowth, and marked stromal cellularity (Figure 2). The phenotype was unspecific but comparable to the breast tumor (Figure 2).
case_images: Spinal MRI revealing paravertebral lesions between T11-T12 causing significant mass effect on the conus medullaris.
case_images: CRIOG2017-8963013.003.jpg
case_images: PMC5660827_01_CRIOG2017-8963013.003.jpg
case_images: fig3
case_images: T11-T12 causing mass effect on the conus medullaris (Figure 3). The occurrence of a cauda equina syndrome indicated an emergency surgery.