PMC6796655_01
Preoperative appearance of breast mass. Image of the breast lesion illustrating the superolateral fungating breast ulcer on a large, irregularly shaped, nodular breast mass.
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There was a superolateral fungating ulcer which was friable and surrounded by inflammatory skin changes and downward nipple displacement (Fig. 1).
Examination findings. 2A: an anterior image of the patient illustrating the limb deformity confined to the right side of the body with limb shortening and irregular angular deformity. 2B: a lateral image of the patient illustrating limb abnormalities. 2C: Image of the patient's right hand illustrating nodular prominences of the bones of the hand and fingers as well as finger shortening and irregular angular deformity.
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She had irregular angular deformity and limb shortening (Fig. 2A and B) of the upper and lower limb, causing a limp favouring the right side as well as shortening and deformity of the thumb and index finger (Fig. 2C) with associated nodularity. She also had a pedunculated, soft hyperpigmented mass on the anterolateral abdominal wall, which was 2 x 2 cm in size (Fig. 2A).
A, B, C, D, E. X-ray images of the patient's bony abnormalities. 3A: Radiographs of the right hand illustrating multiple enchondromas in the phalanges and metacarpals. 3B: Radiographs of the right leg, 3C: right hip, thigh and knee, 3D: right shoulder and arm, 3E: right foot showing multiple enchondromas of the long bones confined to the right side of the body. A calcified phlebolith is visible in the periarticular soft tissues of the right knee joint.
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Radiographs of the right hand revealed multiple enchondromas in the phalanges and metacarpals (Fig. 3A), as well as in the long bones confined to the right side, (Fig. 3B-E).
A, B. Images of gross pathological specimens. 4A: gross specimen of the excised breast showing the dimensions of the tubular adenoma and the well circumscribed mass with a capsule. 4B: images of the gross pathological specimen of the pedunculated skin lesion illustrating phleboliths shown as rounded concretions within the dark soft tissue containing altered blood.
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Pathological examination of the mastectomy sample revealed a large, well-circumscribed breast mass with a well-defined capsule (Fig. 4A). Pathological examination of the skin lesion (Fig. 4B) noted a dermal lesion composed of cystically dilated blood vessels with marked congestion, thrombosis and focal calcification in keeping with a cavernous haemangioma.
A, B, C. Images of the histopathological features of the lesions which were a component of the patient's condition. 5A: Illustrates the tubular adenoma at x40 magnification showing lobules of bland tubular glands lined by 2 layers of cells with a surrounding capsule. 5B: shows histopathological features of the enchondromas from a core biopsy at the distal tibia at x10 magnification. 5C: shows histopathological features of the cavernous haemangioma from the skin lesion with a phlebolith in the capillary lumen at x10 magnification.
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The trabeculae were dense and fibrous with focal calcifications (Fig. 5A). Core bone biopsy of the bony lesions noted lobules of benign cartilage encased by spongy bone marrow consistent with enchondroma with no evidence of malignancy seen (Fig. 5B).