PMC9949754_01
Erythematous, tender breasts with peau d'orange appearance due to dermal lymphatic invasion by tumor emboli. The left breast demonstrates more extensive nodular skin thickening, hyperpigmentation, nipple retraction, and frank ulceration from underlying tumor mass.
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FIG1
Physical examination demonstrated bilateral, asymmetric, tender, immobile breast masses with nipple retraction, peau d'orange appearance, skin hyperpigmentation, and frank ulceration (Figure 1).
CECT of the chest (axial view). (A) Diffuse irregular skin thickening with dermal lymphatic extension and axillary adenopathy, asymmetric bilateral heterogeneously enhancing breast masses with spiculated borders and subtle surrounding fatty stranding, and innumerable metastatic nodules with the replacement of normal fatty hilum that conform to the fibroglandular tissue and axillary nodal stations. There is a central dystrophic calcification within the left breast mass with adjacent infiltration along the anterior chest wall, reticular thickening of the pectoralis musculature, and a malignant left pleural effusion. (B) Enhancing axillary adenopathy, level 1 and level 2 nodes on the left.. CECT: contrast-enhanced computed tomography
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FIG2
CECT of the chest revealed bilateral severe diffuse thickening of the skin overlying both breasts associated with extensive infiltrative fibroglandular densities and nipple retraction, findings supportive of diffuse inflammatory breast disease (Figure 2A). Pathologically enlarged metastatic left-sided axillary lymphadenopathy and multiple small scattered breast masses in the upper inner quadrant of the left breast were also observed (Figure 2B).
(A) CECT of the pelvis (axial view): destructive lytic lesions in the right femoral head and posterior column of the right acetabulum with an underlying pathological fracture (not shown). (B) CECT of the pelvis (axial view): bilateral lytic lesions involving the anterior iliac crests, expansile on the left. (C) CECT of the pelvis (sagittal view): diffuse bony metastases with multiple lytic and blastic lesions throughout the thoracolumbar spine. Pathological fracture seen at T10 with mild vertebral height loss.. CECT: contrast-enhanced computed tomography
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FIG3
CECT of the pelvis demonstrated multiple lytic lesions in the bony pelvis (Figure 3A) and the right femur (Figure 3B). Multiple mixed lytic and blastic lesions to the thoracolumbar spine were also observed (Figure 3C).
PET-CT of the chest (axial view). (A) Infiltrative FDG-avid left breast mass involving substantially the entire breast parenchyma. FDG-avid thickening of the skin involving the entire left breast. Somewhat less-extensive infiltrative mass involving the entire right breast parenchyma with nipple retraction. Diffuse FDG-avid skin thickening of the right breast. (B) Multiple FDG-avid axillary lymph nodes bilaterally, more extensive on the left. No FDG-avid pulmonary masses. FDG-avid moderate-size left pleural effusion. No FDG-avid left lower lobe consolidation, likely representing compressive atelectasis. (C) Bilateral subcutaneous breast tissue uptake with metastatic infiltration of the left pectoralis major muscle (better seen in B), left lower paraesophageal lymph node, and mid-thoracic vertebral arch.. PET-CT, positron emission tomography-computed tomography; FDG, fluorodeoxyglucose
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FIG4
Metastatic adenopathy was identified in the left supraclavicular and bilateral axillary lymph nodes (Figure 4A-4C).
Histology of infiltrating ductal carcinoma involving dermal skin, including scattered dermal lymphovascular invasion.
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FIG5
Bilateral breast pathology revealed triple-positive infiltrating ductal carcinoma with dermal lymphatic involvement (Figure 5).