case_images: PMC4240243_01
case_images: Digital mammography in the CC projection of the right breast demonstrates a large mass involving most of the right breast.. There are scattered calcifications within the mass and overlying skin thickening. This corresponds to the visible and palpable abnormality and is strongly suspicious of malignancy (BIRADS 5).
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case_images: Mammography detected a large mass associated with calcifications and thickening of the overlying skin (BIRADS 5) ( Figure 1).
case_images: Right breast ultrasound demonstrates a large heterogeneous primarily hypoechoic lobulated mass encompassing most of the right breast.
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case_images: Sonographically, the mass was primarily hypoechoic ( Figure 2).
case_images: Breast MRI with contrast, axial view.. In the right breast, there is a large lobulated heterogeneously enchancing mass with multiple areas of non-enchancement consistent with extensive necrosis. On axial image, the mass measures 15 cm x 9 cm x 13 cm. In the left breast, there is no suspicious mass. No suspicious adenopathy is seen in the axillae bilaterally.
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case_images: No lymphadenopathy or chest wall involvement was seen ( Figure 3).
case_images: X-Ray right femur, AP view, demonstrates a large lucent lesion of the right femur with endosteal scalloping.
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case_images: An X-Ray of her right femur showed a large lucent lesion with endosteal scalloping, suspicious for metastatic disease ( Figure 4).
case_images: CT chest, abdomen and pelvis with contrast: A new 3 cm soft tissue mass is identified in the subcutaneous fat adjacent to the right iliac crest.
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case_images: A CT of the chest, abdomen and pelvis discovered a new 3 cm soft tissue mass within the soft tissues in the right gluteal region and multiple lung nodules that were either new or have increased in size compared to previous CTs ( Figure 5).
case_images: A. US guided right gluteal mass full-core biopsy with an 18-gauge BioPince.
  B. Metastatic neoplastic spindle shaped cells in the right gluteal lesion (H&E, 400X).
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case_images: An ultrasound guided right gluteal mass full-core biopsy revealed a spindle cell neoplasm similar to the previously excised breast leiomyosarcoma, confirming the diagnosis of metastatic disease ( Figure 6).