PMC5456025_01
(a) Ultrasound demonstrated a solid mass at the site of palpable concern in the right breast upper outer quadrant. Core biopsy showed sheets of (b) high-grade neoplastic cells, with (c) focal comedonecrosis.
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Targeted ultrasound of the area of palpable concern in the right breast upper outer quadrant demonstrated a corresponding 1-cm solid mass (Figure 1(a)). Histologically, tumor was characterized by sheets and nests of highly pleomorphic, mitotically active neoplastic cells infiltrating the breast parenchyma, with focal comedonecrosis (Figure 1(b) and (c)).
Biopsy of the second mass featuring diffusely infiltrating pleomorphic tumor cells (a) with a prominent single-cell growth pattern and (b) with a thin rim of lymphoid tissue suggestive of an underlying lymph node structure. (a and b) Diffuse staining with (c) pan-melanoma and (d) tyrosinase and patchy staining with (e) AE1/3 cytokeratin immunohistochemical stains.
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In addition, the tumor appeared to be well circumscribed with a thin rim of lymphoid tissue on one edge, suggestive of a replaced intra-parenchymal lymph node (Figure 2(a) and (b)). The neoplastic cells were positive for cytokeratin AE1/3 (patchy), pan-melanoma, tyrosinase, and SOX-10 and negative for CK7, CAM5.2, and GATA-3 (Figure 2(c)-(e)). Brain magnetic resonance imaging (MRI) demonstrated left temporal lobe metastasis, which was also histologically confirmed (Figure 2(b)).