PMC9561385_01
The Doppler ultrasound test of the breast and axilla demonstrated a large, 1.85 x 1.12 x 1.54 cm   retro-areolar lump at the 8 o'clock position (A). The CT scan of the thyroid presented a 4-mm calcium lesion in the left lobular (B). The Doppler ultrasound test of the thyroid gland showed a large, 0.65 x 0.58 x 0.65 cm TI-RADS 4a solid nodule with calcification found in the middle-upper part of the left lobular (C).
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BI-RADS 4b ( Figure 1 ). Because of economic reasons, the patient refused PET/CT test. TI-RADS 4a solid nodule with calcification was found in the middle-upper part of the left lobular of the thyroid gland, which is the opposite side of lymph node metastasis ( Figure 1 ). The CT scan of the thyroid presented a 4-mm calcium lesion in the left lobular ( Figure 1 ). The thyroglobulin (TG) is 2.31 ng/ml.
The pathological result demonstrated an invasive breast carcinoma with ductal carcinoma in situ
(A) and breast cancer axillary lymph node macro-metastasis in H&E staining (B) (H&E, x200 original magnification).
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The final pathological results demonstrated a large, 12-mm non-special type invasive breast carcinoma (grade 2), with about 20% ductal carcinoma in situ ( Figure 2 ). Microscopically, breast cancer cells in the lymph nodes were arranged in a solid nest-like or sheet-like pattern typically, with disordered cell polarity, deep-stained nuclei, eosinophilic cytoplasm, and visible nuclear fission images ( Figure 2 ).
The pathological result of the thyroid papillary carcinoma nodule with an intact membrane (A). Thyroid cancer axillary lymph node metastasis in H&E staining (B) (H&E, x100 original magnification).
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The nuclear outline was irregular, and nuclear groove formation and pseudo-inclusion bodies were seen ( Figure 3 ). The pathological result of thyroid cancer confirmed papillary carcinoma (BRAF positive) ( Figure 3 ).
The timeline showcases the results of FT3, FT4, TSH, and TG levels of the patient before surgery and subsequent follow-ups. FT3, free triiodothyronine; FT4, free thyroxine; TSH, thyroid-stimulating hormone; TG, thyroglobulin.
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As the patient had a high recurrence rate, the thyroid-stimulating hormone (TSH) level is controlled well according to the 2015 ATA guidelines ( Figure 4 ).