PMC4378697_01
Subcutaneous mass invading left breast tissue (from previous admission).
CRIPU2015-136970.001.jpg
PMC4378697_01_CRIPU2015-136970.001.jpg
fig1
A 48-year-old African American male with a past medical history of infiltrating poorly differentiated left breast cancer (Figure 1) without lymph node involvement s/p modified radical mastectomy (MRM) along with axillary dissection 2 months earlier, COPD, bipolar disorder, and chronic smoking (20 pack-years) presented to the ER with progressive SOB for the past 2 months.
Left abdominal wall mass.
CRIPU2015-136970.002.jpg
PMC4378697_01_CRIPU2015-136970.002.jpg
fig2
There was a soft, nontender mobile mass in the periumbilical area which was 2 cm x 2 cm x 2 cm in size and appeared to be superficial on examination (Figure 2).
Chest X-ray: Rt upper lobe mass.
CRIPU2015-136970.003.jpg
PMC4378697_01_CRIPU2015-136970.003.jpg
fig3
The chest X-ray was reported as a deviation of the tracheal lumen to the left without obstruction and a right upper hemithorax mass (Figure 3).
Chest CT scan: Rt upper lobe density.
CRIPU2015-136970.004.jpg
PMC4378697_01_CRIPU2015-136970.004.jpg
fig4
CT scan reported a large right upper lobe lung mass suspicious for malignancy, bullous emphysematous disease with pulmonary fibrosis, and mediastinal lymphadenopathy with small pleural effusion on the right (Figure 4).
Lung transbronchial biopsy specimen: poorly differentiated cluster of neoplastic cells with abundant cytoplasm with hyperchromatic nuclei. No gland or sheets of squamous cell formation.
CRIPU2015-136970.005.jpg
PMC4378697_01_CRIPU2015-136970.005.jpg
fig5
Biopsy results of the abdominal mass came back as high-grade malignant neoplasm with unclear etiology whereas the lung mass biopsy was reported as poorly differentiated non-small-cell lung cancer (Figures 5 and 6).
Abdominal wall biopsy specimen: poorly differentiated neoplastic cells with abundant cytoplasm with hyperchromatic nuclei. No gland or sheets of squamous cell formation.
CRIPU2015-136970.006.jpg
PMC4378697_01_CRIPU2015-136970.006.jpg
fig6
Biopsy results of the abdominal mass came back as high-grade malignant neoplasm with unclear etiology whereas the lung mass biopsy was reported as poorly differentiated non-small-cell lung cancer (Figures 5 and 6).
Left breast tissue (high power): poorly differentiated malignant cells, prominent nucleoli.
CRIPU2015-136970.007.jpg
PMC4378697_01_CRIPU2015-136970.007.jpg
fig7
The markers for breast and lung cancer (ER, PR, HER2, GCDPF-15, Mammaglobin, BCA225, GATA3, anti-TTF, CK7/20, and napsin A) were negative in all biopsies taken (breast (Figures 7 and 8), lung, and abdominal wall); however since the patient was male and a chronic smoker the diagnosis was made as Stage IV non-small-cell lung cancer with soft tissue metastases to both the abdominal wall and breast.
Infiltrating poorly differentiated carcinoma and surgical margin free of tumor. No ductal and no parenchymal tissues identified.
CRIPU2015-136970.008.jpg
PMC4378697_01_CRIPU2015-136970.008.jpg
fig8
The markers for breast and lung cancer (ER, PR, HER2, GCDPF-15, Mammaglobin, BCA225, GATA3, anti-TTF, CK7/20, and napsin A) were negative in all biopsies taken (breast (Figures 7 and 8), lung, and abdominal wall); however since the patient was male and a chronic smoker the diagnosis was made as Stage IV non-small-cell lung cancer with soft tissue metastases to both the abdominal wall and breast.
Head CT scan showing multiple brain metastases left breast tissue (low power field).
CRIPU2015-136970.009.jpg
PMC4378697_01_CRIPU2015-136970.009.jpg
fig9
Furthermore, head CT indicated multiple brain metastases (Figure 9).