PMC4929343_01
Time course. Tests and episodes that occurred between the mass discovery and surgery.
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When a chest computed tomography (CT) scan was performed to confirm the fat engraftment, a mass was identified in the upper-inner quadrant of the left breast (Fig. 1), and the patient was referred to our department.
(a) Ultrasonography at the initial diagnosis. A morphologically irregular (13 x 9 x 12 mm) and sharply demarcated hypoechoic mass with a rough surface and internal heterogeneity was found in the left upper-inner quadrant (arrow). Posterior ultrasonography was unchanged. There was no lateral shadow. A hyperechoic area was observed in the tumor border. A papillotubular carcinoma with scirrhous invasion was suspected. (b) Ultrasonography immediately before surgery. The identified mass had reduced to 10 x 7 x 4 mm (arrow).
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An echogenic halo was observed in the surrounding tissue (Fig. 2a). FNA). Forty-seven days post-CT, a pre-operative ultrasound revealed tumor shrinkage (10 x 7 x 4 mm; Fig. 2b), and no symptoms of inflammation such as heat, swelling, pain or redness were noted on clinical examination.
(a) FNA: x200 magnification. A cluster with an aggregated arrangement and a loss of adhesion was observed. (b) FNA: x400 magnification. A small agglomeration, ICL (arrow) and a restiform arrangement (arrowhead) were observed. (c) FNA: x400 magnification. A typical cells and mitoses (arrow) were observed.
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Given these findings, an invasive ductal carcinoma was suspected and we diagnosed malignant as per the Japanese breast cancer society (Fig. 3).
(a) Non-contrast MRI: T2WI. High intensity was observed at the center of the tumor. (b) Non-contrast MRI: DWI. Accumulation at the center of the tumor suggested inflammation or a malignant component.
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The MRI revealed a mass lesion adjacent to the chest wall in the upper inner quadrant (low intensity on T1-weighted imaging, high intensity on T2-weighted imaging and high intensity on diffusion-weighted imaging), which was thought to be a malignant mass or inflammation (Fig. 4).
(a) Surgical specimen: hematoxylin and eosin. (H.E.), x200 magnification. Fibrosis and lymphocytic infiltration were observed in an area of approximately 10 x 10 mm. (b) Surgical specimen: H.E., x400 magnification. Coagulative necrosis was detected at the center of the tumor.
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Coagulative necrosis was observed in the center of the specimen (Fig. 5).