case_images: PMC11193393_01
case_images: B-ultrasound images before treatment: This shows irregular hypoechoic clusters behind the left papillae, with irregular edges and uneven internal echoes, with parts of the area crisscrossing the surrounding tissue in a canine interlacing pattern, and no changes in echoes seen behind the multiple internal calcification points (a and b). CDFI: low echo mass and short rod-shaped blood flow signal within it (c). Following treatment, a reduction in the irregular hypoechoic mass was observed, with lobular structure and clear boundaries with surrounding tissue (d and e), CDFI: abundant blood flow signals in the hypoechoic mass (f).
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case_images: B-ultrasonography of both mammary glands showed the presence of irregular hypoechoic clusters of about 6.3 cm x 5.3 cm and 2.2 cm x 1.2 cm in size behind the left papillae and beside the papillae at 11 o'clock, respectively (Figure 1a-c). After six cycles of treatment, the sizes of the tumors in the left breast were reduced from 6.3 cm x 5.3 cm (Figure 1a-c) to 4.5 cm x 3.3 cm (Figure 1d-f) and from 2.2 cm x 1.2 cm to 1.2 cm x 0.9 cm, respectively.
case_images: Immunohistochemistry of the needle biopsy from the breast. Hematoxylin and eosin staining demonstrating (a) diffuse and patchy appearance of the tumor cells, with medium to large cell sizes (original magnification x200); (b) tumor cells showing irregular chromatin, significant nucleoli, and normal mitosis (original magnification x400). The staining of specific cell markers displayed diffused positive staining for (c) CD20; (d) Bcl-2; and (e) Ki67.
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case_images: The tumor infiltrate showed a diffuse growth pattern consisting of large cells with mostly immunoblastic appearance (large nuclei with coarse chromatin, prominent nucleoli, and basophilic or vacuolar cytoplasm), together with increased mitotic activity (Figure 2a and b). Tests for MYC, Bcl-2, and Bcl-6 gene rearrangements (fluorescence in situ hybridization) were negative (Figure 2c-e).
case_images: CT scan of tracheostenosis before (a) and after (b) changing the treatment regime for RS with breast involvement and tracheal invasion. (a) Manifestations of severe tracheostenosis. (b) Significant improvement in tracheostenosis.
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case_images: This narrowed the local airway to 7.4 mm x 5.2 mm (lung window measurement) and thickened the surrounding soft tissues, suggesting tumor invasion (Figure 3a). CT re-examination 2 days after the R-EPOCH treatment showed that the focal stenosis at the thoracic entrance of the trachea had improved significantly, and the narrowest part of the trachea had increased in size to 11 mm x 7 mm from the previous 7.4 mm x 5.2 mm (lung window measurement) (Figure 3b).
case_images: Tracheoscopy of the middle and upper trachea. (a) Local swelling and stenosis can be observed on the tracheal wall, with a 1-mm x 1-mm mass at the upper right portion protruding from the tube wall (black arrow). (b) Enlargement of the view of the white necrotic areas on the tracheal surface.
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case_images: Tracheoscopy showed focal stenosis and a suspicious mass in the middle and upper trachea, suggestive of tumor infiltration (Figure 4).