case_images: PMC7201766_01
case_images: (A) Diagnostic Mammogram: Right medio-lateral oblique view showing an irregular high density mass in the superior central aspect of the right breast. (B) Ultrasonography of right breast and axilla: Irregular hypoechoic macro-lobulated mass in the superior central aspect of the right breast.
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case_images: PMC7201766_01_fendo-11-00228-g0001.jpg
case_images: F1
case_images: Diagnostic mammogram and ultrasound (Figures 1A,B) indicated a 2.3 x 1.3 x 2.3 cm irregular mass in the upper outer quadrant of the right breast, highly suggestive of malignancy.
case_images: (A) Histopathological examination of the specimen stained on low (4x), (B) high power field (20x, 40x) showed neoplastic cells with high nuclear: cytoplasmic ratio, hyperchromatic nuclei, minimal cytoplasm, and indistinct nuclei, nuclear molding, high mitotic rate, consistent with the diagnosis of small cell carcinoma. Biopsy of breast cancer primary. Immuno-histochemical staining for TTF-1 synpatophysin, chromogranin, and p40 and smooth muscle myosin staining (SMMS) consistent with a diagnosis of primary SCCB, (C) small cell synaptophysin 20X. (D) small cell TTF-1 20X. (E)
  In situ component with neuroendocrine differentiation p40. (F)
  in situ component smooth muscle myosin stain. (G) Histopathological examination of the fine needle aspiration of the sub-carinal node revealed metastatic small cell carcinoma (Lymph node 40x).
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case_images: PMC7201766_01_fendo-11-00228-g0002.jpg
case_images: F2
case_images: Ultrasound guided core needle biopsy revealed poorly differentiated neuroendocrine carcinoma/small cell carcinoma (Figures 2A,B), estrogen receptor (ER) negative, progesterone receptor (PR) positive (10% weak intensity), and human epidermal growth receptor 2 (HER2) negative. Immuno-histochemical staining was positive for thyroid transcription factor 1 (TTF-1), synaptophysin and chromogranin A, and rare cells positive for GATA3, consistent with primary SCCB (Figures 2C,D). In addition, a high grade neuroendocrine in situ component was identified (Figures 2E,F). Bronchoscopy and trans-bronchial fine needle aspiration of the sub-carinal node revealed metastatic small cell carcinoma with Ki-67 staining in >90% of cells (Figure 2G).
case_images: (A) PET CT scan showing the primary lesion in the right upper outer quadrant of the right breast. (B) A hyper metabolic right axillary lymph node, which is compatible with the patient's known right breast primary malignancy and a presumed metastatic right axillary lymph node. (C) PET scan after recurrence showing new lung nodules with FDG uptake. (D) PET scan after recurrence showing sub-carinal lymph node with new intense focus of FDG uptake.
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case_images: PMC7201766_01_fendo-11-00228-g0003.jpg
case_images: F3
case_images: Additionally, a positron emission tomography (PET) computerized tomography (CT) scans showed no evidence of lung, pancreatic, adrenal, or pelvic masses (Figures 3A,B). Routine follow-up CT scans of the thorax showed a right lower lobe nodule and enlarged sub-carinal lymph node, which showed FDG avidity by PET scan (Figures 3C,D).