PMC6301820_01
Immunohistochemical results of the primary invasive left breast carcinoma (original magnification, 200x). The tumor stained negative for both ER (A) and PR (B) but strongly positive for HER-2 (C) and exhibited a Ki-67 proliferation index of 20% (D) .
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The subsequent biopsy demonstrated invasive breast carcinoma with immunohistochemical results of ER(-), PR(-), HER-2(3+), Ki67(+ 20%) and P53(+ 90%)(Figure1).
Brain MRIs of the patient revealed the size of BM lesion and PTBE. (A,C,E,G) The BM maximum diameter slice of T1-weighted MRI with contrast in 03/2017, 11/2017, 02/2018 and 03/2018 respectively. (B,D,F,H) The most obvious slice of PTBE in Flair-weighted MRI in 03/2017, 11/2017, 02/2018 and 03/2018 respectively. As Figure 1F shows, extensive PTBE caused progressive neurological deficits of the patient in 02/2018 which failed to be improved by high dose of steroids and dehydrants. As Figure 1H demonstrates, the PTBE shrank dramatically after use of apatinib 35 days.
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The brain MRI with contrast revealed a lesion measuring about 3.1 x 2.7cm located in the left frontal lobe with circular enhancement and edema around, consistent with metastasis (Figure 2A,B). Flair-weighted MRI showed large area of PTBE, resulting in compression and deformation of bilateral ventricle and midline structure shift to the right (Figure 2E,F). Comparing with the brain MRI in November, 2017 (Figure 2C,D), the BM demonstrated slight increase (2.5 x 2.0cm to 3.8 x 2.2cm) while PTBE increased significantly. The subsequent brain MRI (March, 16, 2018) revealed remarkable shrinkage of PTBE and no obvious change in the BM lesion (Figure 2G,H).