PMC4444565_01
(a) Axial CT with intravenous contrast. The appendix is seen anterior to the right psoas muscle belly and is with a little surrounding free fluid (solid black arrow). Increased attenuating soft tissue in the right paracolic gutter suggests free fluid or secondary peritoneal metastases (broken arrow). (b) Coronal section of the same patient demonstrating the enhancing appendix medial to the caecum. Mural enhancement is commonly seen in appendicitis. However, in this case, there is little surrounding fat stranding and no fluid filled lumen is seen; these features are more atypical. Enlarged lymph nodes are seen in the mesentery (solid white arrow).
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A contrast CT scan of the abdomen and pelvis found increased attenuation with mild thickening of the appendix and a small amount of free fluid in the right paracolic gutter; an enlarged lymph node was also seen in the right iliac fossa (Figure 1).
(a) Ultrasound of the left breast showing a 15 mm ill-defined hypoechoic mass. (b) Mammogram of left breast (mediolateral view) demonstrates a spiculate mass (red circle).
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Imaging of the left breast (mammograms and ultrasound scan) showed an ill-defined spiculate mass measuring 30 mm by 27 mm (Figure 2) and enlarged left axillary lymph nodes.
Submucosa shows diffuse infiltration by small to moderate sized malignant epithelial cells with prominent trabecular/Indian filing pattern and vesicular nucleolated nuclei. There is no evidence of glandular formation (H&E stain, magnification x10).
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Areas of angiolymphatic invasion were also present (Figure 3).
(a) Several malignant ductal structures in a desmoplastic stroma (H&E stain, magnification x20). (b) Breast biopsy shows typical lobular carcinoma pattern with Indian filing (H&E stain, magnification x40).
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The breast core biopsies showed a grade 1 invasive ductal carcinoma with some lobular differentiation (Figure 4) and low grade ductal carcinoma in situ.
T1 weighted MRI orbits show soft tissue replacing fat in the medial left orbit is isointense with the adjacent recti and it is suggestive of a soft tissue deposit (white arrows).
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The MRI scan showed a left retroorbital, intraconal soft tissue mass between the medial and inferior recti muscles, suggestive of a metastatic deposit (Figure 5: MRI orbits).