PMC6159208_01
US scan showed diffuse stromal thickening in the background of heterogeneous parenchyma corresponding to the area of palpable thickening in the right lateral breast.
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Ultrasonography, however, revealed diffuse stromal thickening in the background of heterogeneous parenchyma corresponding to the area of palpable thickening in the right lateral breast with no focal mass or nodule (Figure 1).
Tru-cut biopsy of breast lump showed invasive carcinoma, with diffusely positive staining for TTF-1 (inset) on immunohistochemistry (TTF-1: Thyroid transcription factor-1).
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Ultrasound-guided 14G core needle biopsy was performed, and histology confirmed a metastatic adenocarcinoma with an immune-profile favouring a lung primary (Figure 2).
CT scan in the lung window showed a mass in the lingula lobe of the lung, in keeping with a primary tumour.
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Further imaging with a CT scan showed a lingula lobe primary tumour with extensive skeletal metastasis (Figures 3 and 4).
CT scan in the bone window showed sclerotic bony metastases to the ribs and spine.
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Further imaging with a CT scan showed a lingula lobe primary tumour with extensive skeletal metastasis (Figures 3 and 4).
PMC6159208_02
(a, b) Bilateral breast mammogram showed a 0.6 cm mass in the lower inner quadrant of the left breast.
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Subsequent mammography revealed a nodule in the lower inner quadrant of left breast with no associated micro-calcification or architectural distortion (Figure 5a,b).
US scan showed an iso-echoic nodule at 7 o'clock in the left breast, corresponding to the mammographic lesion.
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Ultrasonography revealed a 0.6 x 0.6-cm iso-echoic nodule corresponding to the nodule in mammogram (Figure 6).
Tru-cut biopsy of breast lump showed extensive lymphovascular involvement by metastatic lung carcinoma. Inset: TTF-1 positive (thyroid transcription factor immunohistochemistry); 10x magnification.
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Ultrasound-guided 14G core needle biopsy was performed, and histology with immunostaining revealed a metastatic adenocarcinoma from a lung primary (Figure 7).
PMC6159208_03
US scan showed a large lobulated mass at 12 o'clock in the left breast, surrounded by a few breast cysts.
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Several large cysts were also noted in both breasts (Figure 8).
Post-contrast enhanced fat suppressed axial T1 weighted MR scan showed a left breast mass (upper arrow) and left lower lobe lung mass with associated atelectasis. (lower arrow).
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The MR also further demonstrated a left lower lobe lung mass and associated atelectasis (Figures 9-11).
Post-contrast enhanced fat suppressed sagittal T1 weighted MR scan shows the dominant mass in the left breast with surrounding several smaller enhancing nodules compatible with metastatic lesions.. The image also shows the enhancement kinetic curve of the dominant lesion which is the "washout" or Type III pattern. This pattern is suggestive of malignancy.
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The MR also further demonstrated a left lower lobe lung mass and associated atelectasis (Figures 9-11).
Unenhanced fat suppressed axial T2 weighted MR scan showed several cysts of varying sizes in both breasts.
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The MR also further demonstrated a left lower lobe lung mass and associated atelectasis (Figures 9-11).
Tru-cut biopsy of breast lump showed a necrotic tumour with infiltrating pleomorphic cells that resemble a poorly differentiated invasive carcinoma, likely from the lung.
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Ultrasound-guided 14G core biopsy of the left breast mass revealed a poorly differentiated adenocarcinoma, likely of lung origin (Figure 12).