PMC5983020_01
Preoperative axillary photo of patient.. Notes: Before surgery, the large mass on the left axillary was visibly prominent (A and B). Arrows indicate the lesion of interest.
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By then, the tumor had reached 10x8 cm2 limiting left upper arm motor function (Figure 1).
Imaging of ultrasound and MRI examination of breast.. Notes: (A) A low echo mass of 8x5 cm2 can be seen in the left axilla by ultrasound examination. The boundary was unclear, and the shape was irregular. (B) The mass in the left axilla manifested as unclear boundary and unequal signal by MRI. T1W1 and T2W1 revealed mixed signal with uneven enhancement. Arrows indicate the lesion of interest.. Abbreviation: MRI, magnetic resonance imaging.
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In addition, there was an irregular and inhomogeneous low echogenic mass in the subcutaneous soft tissue deep within the left axilla measuring 8 cm in longest diameter (Figure 2A) with irregular borders and scant blood flow signal. In contrast, the mass within the left axilla revealed irregular borders and signal (Figure 2B).
Imaging of 18 F-fluorodeoxyglucose (FDG) PET/CT.. Notes: The saccharometabolism of the left axillary mass was in homogeneously increased and the lesions were not clear with the boundary of musculi teres minor, subscapalaris and the scapula on the left. Left side vertical images (transverse section of the chest): The images from top to bottom are CT plain scan, PET plain scan, and the synthesis of PET and CT images. Upper right images (front projection of human body): The images from the second to the fourth are CT plain scan, PET plain scan, and the synthesis of PET and CT images. Lower right images (side projection of human body): The images from the second to the fourth are CT plain scan, PET plain scan, and the synthesis of PET and CT images.
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The lesion could not be easily separated from adjacent muscle including the musculi teres minor, the subscapalaris, and the scapula itself (Figure 3).
Image of core needle biopsy histologic diagnosis using hematoxylin and eosin staining (scale bar =2,000 mum; original x100).. Note: Glassy degeneration and focal vascular hyperplasia can be seen in the fibrous tissue.
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A core needle biopsy demonstrated fibrous tissue with glassy degeneration and focal vascular hyperplasia (Figure 4).
Intraoperative photo of the mass.. Notes: (A) The complete appearance of the tumor. (B) Tumor section image. The mass was large (12x11 cm2), and the section of the mass was presented as fibrous tissue interleaving.
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At the time of surgery, the mass was extremely hard with an incomplete capsule and could not be easily separated from surrounding tissues (Figure 5).
Image of paraffin pathology histologic diagnosis using hematoxylin and eosin staining (scale bar =2,000 mum; original x100).. Notes: (A) An abundance of spindle cells is evident. (B) Tumor involvement in striated muscle is seen.
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Intraoperative pathology result suggested a spindle cell tumor (Figure 6A) which was confirmed on permanent paraffin sections with infiltration into striated muscle (Figure 6B).
Expression of beta-catenin, SMA, vimentin, and CD34 by IHC staining (scale bar =2,000 mum; original x 100).. Notes: (A) beta-Catenin positive expression can be detected by IHC staining. (B) SMA positive expression can be detected by IHC staining. (D) CD34 positive expression can be detected by IHC staining.. Abbreviations: IHC, immunohistochemistry; SMA, smooth muscle actin.
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Bcl 2; and positive for beta-catenin, smooth muscle actin, vimentin, and CD34 (Figure 7). Based on these findings, the patient was diagnosed with a left axillary AF.