PMC5910505_01
Abdominopelvic CT scan; a-c. Massive cystic lesion originating from the right ovary and multiple osteoblastic lesions in the displayed bones; d. Enlarged lymph node in the lesser curvature of stomach.
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Abdominopelvic CT scan showed a massive cystic lesion with dimensions of 13 x 10 x 16 cm originating from the right ovary, multiple osteoblastic lesions in the displayed bones and a sole enlarged lymph node 1,3 cm in the lesser curvature of stomach and a cystic lesion of 2,6 cm in the 4A segment of the liver [Fig. 1].
Digital mammography; a-c. Grouped punctate and diffused microcalcifications on the upper outer quadrant of left breast (L-CC); CESM; d,e. Scattered regions with confluent microcalcifications on the left breast; CESM; f. No abnormal areas of enhancement in left breast; CESM; g. No abnormal areas of enhancement in right breast.
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Digital mammography revealed 3 clusters of grouped punctate microcalcifications and a few diffused ones, on the upper outer quadrant of left breast with a distance of 7-10 cm from the nipple (ACR BI-RADS classification 2) [Fig. 2]. CESM revealed scattered regions with confluent microcalcifications on the left breast and no abnormal areas of enhancement in either breast after the iv injection of iodinated contrast material or visual masses suspected for neoplastic proliferation [Fig. 2].
a. Massive infiltration by non-cohesive neoplastic cells in the endo-myometrium (H-E)(X100); b. Immunohistochemical stain for Estrogen Receptors (ER) positive in neoplastic cells in the appendix (X100); c. Breast biopsy revealed diffuse infiltration by lobular type carcinoma with typical features and adjacent intraepithelial (in situ) lobular cancer (H-E X100).
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Similarly, metastases to the omentum, appendix, excised lymph nodes, cervix and myometrium were revealed [Fig. 3]. Histologic examination of surgical specimens identified that the mammary gland was totally invaded from lobular carcinoma grade 2, with co-existing in situ lobular carcinoma outspread to ducts with necrosis and calcifications [Fig. 3].
Bone scanning; a. Increased radionuclide uptake along the occipital bone; b,c. Increased radionuclide uptake along the sternum; d,e. Increased radionuclide uptake along the pelvis and sacrum; f. Increased radionuclide uptake along the vertebral column.
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Bone scanning revealed areas of increased radionuclide uptake along the vertebral column, sternum, pelvis, sacrum, occipital bone and vertebrosternal ribs; findings compatible with metastatic disease [Fig. 4].
Postoperative image of left breast after the quadrantectomy of the upper outer quadrant.
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She was hospitalized for 11 days and was discharged on the 12th postoperative day, in good condition, without postoperative complications [Fig. 5].