PMC6284526_01
Pathological results of the resected bowel deposit.. Notes: (A) The postoperative gross specimen showed a circumferential lesion located in the small intestine measuring about 2.5x2x1.5 cm and causing the proximal bowel dilation. The cut surface of the tumor is grayish white, solid, and hard. (B) Hematoxylin-eosin stained section revealed submucous invasion of cancer cells (original magnification: 100x). (C) Hematoxylin-eosin stained section documented neoplastic cells infiltrated muscular layer exhibiting nest-like pattern (original magnification: 200x).
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The tumor was 2.5x2x1.5 cm and infiltrated the whole layers of the small intestine and appendiceal serosal layer (Figure 1).
IHC results suggestive of bowel metastasis of BC origin (upper left part: normal intestinal mucosa; lower right part: tumor infiltrating part.). Notes: (A-C) ER, GCDFP-15, and CA153 were intensively positive for tumor cells (original magnification: 100x). (D) CK7 was partly positive for tumor cells (original magnification: 100x) while (E-G) CK20, Villin, and PR were negative for neoplastic cells (original magnification: 100x). (H) Ki-67 expressed in the nuclei of ~10% of tumor cells (original magnification: 100x).. Abbreviations: BC, breast cancer; ER, estrogen receptor; IHC, immunohistochemistry; PR, progesterone receptor.
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Immunohistochemically, the neoplastic cells were positive to estrogen receptor (ER), gross cystic disease fluid protein 15 (GCDFP-15), CA153, and cytokeratin (CK)7 while negative to CK20, Villin, and progesterone receptor (PR) which supported the bowel metastasis of BC (Figure 2A-G). Ki-67 expressed in the nuclei of approximately 10% of tumor cells (Figure 2H).
Selective cranial MRI scan images of skull involvement.. Notes: (A, B) Head MRI of July 2016 revealed multiple bone destruction in left frontal bone, temporal bone, and lateral orbital wall. (C, D) In January 2018, the skull metastasis progressed with obvious localized soft tissue lesions.
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Reexamination of head MRI revealed multiple bone destruction in left frontal bone, temporal bone, and lateral orbital wall (Figure 3A and B). In January 2018, the skull involvement progressed (Figure 3C and D) and she underwent local radiotherapy of 56 Gy/28 f with a stable disease response.