PMC3818837_01
X-ray of the head showing multiple lucent calvarial defects described as lytic lesions.
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CT scan of the head showed no parenchymal abnormalities but revealed multiple lucent calvarial defects consistent with lytic lesions which were also seen on a plain film (Figure 1). A skeletal survey was done and lytic lesions were found only in the calvarium of the skull (Figure 1).
Breast Mammogram. (a) A large, hyperdense lobular shaped mass with smooth margins in the left breast, measuring 19 x 14 x 17 cm. (b) Left axilla showing a 6 cm large abnormal lymph node mass.
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There was also a 6 cm abnormal lymph node in the left axilla (Figures 2(a) and 2(b)).
Ultrasound guided core biopsy. (a) Hematoxylin and eosin-stained section shows core needle core biopsy with dense infiltrate of atypical lymphocytes with no residual normal breast tissue being identified (20x). (b) High magnification to demonstrate sheets of large transformed cells with round to irregular nuclei, dispersed chromatin, and prominent nucleoli (400x). Immunohistochemistry stains for (c) CD3; (d) CD20; (e) Ki-67.
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There was prominent apoptotic material, focal areas of geographic necrosis, and some areas with a "starry sky appearance." Immunostains were strongly positive for CD20, CD3, and high Ki67 index (Figure 3).