PMC7473977_01
Positron emission tomography and computed tomography image (A) and computed tomography image (B) on March 18, 2019.
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PET-CT scanning revealed the following: 1) multiple lymph node metastases in the mediastinum, bilateral portal, and left lower lung; 2) metastatic tumor in the basal segment of the right lower lobe; 3) right scapula metastasis; 4) sixth left rib metastasis accompanied by mass in the soft tissues with SUVmax of 17.2 (Figure 1A and B).
Hematoxylin-eosin staining of the first biopsy and immunohistochemistry of the thoracic mass. (A) Hematoxylin-eosin staining. (B) Estrogen Receptor. (C) Progesterone Receptor. (D) Ki-67.
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IV lymph node in the right cervix showed metastatic poor differentiated carcinoma. Immunohistochemistry showed the following findings: 1) ER 90% moderately to strongly positive, PR about 15% moderately to strongly positive, Cerb-2 2+, Ki-67 30% (+), GATA3 (+), and GCDFP-15 (-), and few mammaglobin (+) on slide 1 (Figure 2); 2) GATA3 (+), GCDFP-15 (-), and CK7 (+) on slide 2.
(A) Computed tomography image at the first re-examination on June 17, 2019. (B) Positron emission tomography and computed tomography image on June 24, 2019.
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Re-examination with CT scan on June 17, 2019, after three cycles of treatment, showed that the metastasis in the sixth left rib and the mass in the soft tissue progressed, which affected the fifth and sixth intercostal spaces; while the other metastases regressed (Figure 3A). PET-CT scanning showed that the mass in the soft tissues of the sixth left rib increased, and the SUVmax was 12.4 (Figure 3B); the other metastases regressed, and the SUV values decreased. Physical examination did not reveal any enlargement of the superficial lymph nodes, and the mass in the left anterolateral thoracic wall was flattened without pain during pressing.
Hematoxylin-eosin staining of the second biopsy and immunohistochemistry of the thoracic mass. (A) Hematoxylin-eosin staining. (B) Estrogen Receptor. (C) Progesterone Receptor. (D) Ki-67.
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Immunohistochemistry showed ER 75% strongly positive, PR 60% weakly positive, Cerb-2 2+, Ki-67 1% (+), GATA3 (+), and P120 (membrane+) (Figure 4).
Re-examination with thoracic computed tomography scanning on July 31, 2019.
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Then re-examination with thoracic CT scanning was conducted, which showed that the metastasis in the sixth left rib and mass in the soft tissue regressed, and bone reconstruction was observed (Figure 5).
Positron emission tomography and computed tomography image on October 28, 2019.
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The re-examination with PET-CT scanning was conducted on October 28, 2019, showing the bone destruction at the sixth left rib accompanied by the mass approximately 3.19x2.05 cm2 in size and SUVmax 12.4 that continuously regressed in the soft tissues (Figure 6).
Hematoxylin-eosin staining of the third biopsy and immunohistochemistry of the thoracic mass. (A) Hematoxylin-eosin staining. (B) Estrogen Receptor. (C) Progesterone Receptor. (D) Ki-67.
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FISH was negative (Figure 7).