PMC7481530_01
Mammography of the left breast.. Mammography shows an irregular, indistinct, partially spiculated mass with a diameter of 29 mm at the (a) upper-middle mediolateral oblique view, and at (b) middle-medial craniocaudal view. No calcification is detected.
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Mammography showed an irregular, indistinct, partially spiculated mass without calcification (Fig. 1).
Ultrasonography of the left breast.. Ultrasonography shows an irregular hypoechoic mass with indistinct margin and posterior shadowing at the 10 o'clock position of the left breast. Its size is 26 x 14 x 16 mm.
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The ultrasonogram showed an irregular hypoechoic mass in the 10 o'clock position of the left breast (Fig. 2).
Ultrasonography of the left axillary lymph node.. Ultrasonography showed a lymph node with an eccentric cortical thickening at the left levelIof the axilla.
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In the left axilla, there was an 18 x 8 mm node with an eccentric cortical thickening at level I (Fig. 3).
Whole body 18F-fluorodeoxyglucose positron emission tomography/computed tomography ([F-18]FDG PET/CT).. (a) Minimum-intensity projection, whole-body PET image. (b) Cross-section of the primary lesion, PET/CT. (c) Cross-section of the axillary lymph node, PET/CT. [F-18]FDG accumulation was slight in both primary lesion and axillary lymph node metastases (maximum standardized uptake values of 1.7 and 1.4, respectively, see arrows).
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Owing to the equivocal uptake of the left ALN at level I after FNA (SUVmax = 1.4), we could not conclude whether the test was positive for metastasis (Fig. 4).
Ultrafast dynamic MRI.. (a) Minimum-intensity projection (MIP), fat-suppressed T1-weighted image (FST1WI), precontrast, 1st, 3rd, 5th, 7th (upper row, from left to right), 9th, 11th, 13th, 15th, 17th (lower row, from left to right) phase of ultrafast dynamic series.. Breast lesion begins to be enhanced from the 8th phase of the ultrafast dynamics study (arrow) and the left axial lymph node begins from the 7th phase (arrowhead). Ultrafast dynamic MRI does not show other ipsilateral and contralateral axillary lymph nodes.. (b) Time-intensity curves of aorta (1), breast lesion (2), metastatic left axillary lymph node (3), and normal lymph node of the right axilla (4) based on the ultrafast dynamic series.. The left metastatic lymph node enhanced much earlier than a normal lymph node.
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I. It was enhanced from the 7th phase of the ultrafast series at a much earlier stage than other lymph nodes on the ipsilateral and the contralateral axilla (Fig. 5a and b).
Histopathology of the left breast cancer and the axillary lymph node.. (a) Shows an invasive lobular carcinoma of the breast (hematoxylin-eosin stain, loupe).. (b) Shows axillary lymph node metastasis (hematoxylin-eosin stain, original magnification, x10). The tumor cells show the same morphologic features as the primary lesion (arrows). An extranodal extension is observed (arrowheads).
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A breast specimen revealed invasive lobular carcinoma with scattered lobular carcinoma in situ (Fig. 6a). The patient had 16 of the 28 ALN metastases with the extranodal invasion at levels I and II (Fig. 6b).