PMC5253706_01
Mammogram performed with mediolateral oblique incidences of both breasts shows multiple oval well-defined masses located in the right breast (A) and a round lesion with fine spiculated borders located on the superior quadrant of the left breast (B) associated with smaller round lesions.
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F1
A mammogram was performed with only mediolateral oblique incidences because of breast discomfort (Figure 1).
Ultrasound of both breasts demonstrates one of the multiple masses located on the right breast (A) which is characterized by an oval shape, smooth borders and a hypoechoic appearance. The palpable mass located in the upper outer quadrant of the left breast (B) presents an irregular shape and borders with posterior shadowing suggestive of malignancy.
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F2
Multiple similar well-defined hypoechoic oval masses were observed scattered throughout the remainder of the breasts tissue (Figure 2).
On MRI, multiple round masses are localized in the outer upper quadrant of the right breast, which present a hyperintense signal on T2-weighted images and fat saturation (A) and a hypointense signal on T1-weighted images (B). These lesions present a faint contrast enhancement on gadolinium-enhanced T1-weighted images with fat saturation (C).
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F3
On MRI, all lesions (Figure 3) including the palpable one (Figure 4) were hypointense on T1-weighted images and hyperintense on T2-weighted images.
On MRI, the palpable mass located in the upper outer left quadrant demonstrates a hyperintense signal on T2-weighted images with fat saturation (A) and a hypointense signal on T1-weighted images (B). After gadolinium administration, the mass shows little enhancement and a small necrotic area with enhancing borders (C).
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F4
On MRI, all lesions (Figure 3) including the palpable one (Figure 4) were hypointense on T1-weighted images and hyperintense on T2-weighted images.
Dense myeloid precursor proliferation with breast tissue invasion. Immunostaining is positive for myeloperoxydase, CD68 and CD117, which are markers for myeloid cells.
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F5
Biopsies were positive for myeloperoxydase (MPO), CD68, and CD117, which are markers for myeloid tumors (Figure 5).
Follow-up with MRI shows significant decrease in tumor burden with no evidence of new lesions. A complete response was achieved in most lesions and observed by the absence of contrast enhancement especially in the big cluster of oval masses of the right breast (arrow). T2-weighted images with fat saturation (A); T1-weighted images (B); gadolinium-enhanced T1-weighted images with fat saturation (C).
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F6
Follow-up with breast MRI (Figures 6 and 7) showed partial response of the breast disease within 1 month with complete resolution of almost all known lesions and absence of new ones: only a small fraction of focal contrast enhancements measuring up to 1 cm were observed during follow-up (Figure 8).
Here, we observe a complete response of the known palpable lesion in the left breast with absence of contrast enhancement (arrow). T2-weighted images with fat saturation (A); T1-weighted images (B); gadolinium-enhanced T1-weighted images with fat saturation (C).
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F7
Follow-up with breast MRI (Figures 6 and 7) showed partial response of the breast disease within 1 month with complete resolution of almost all known lesions and absence of new ones: only a small fraction of focal contrast enhancements measuring up to 1 cm were observed during follow-up (Figure 8).
Gadolinium-enhanced T1-weighted images with fat saturation showing a remaining 1-cm focal enhancement 1 month after therapy (arrow).
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F8
Follow-up with breast MRI (Figures 6 and 7) showed partial response of the breast disease within 1 month with complete resolution of almost all known lesions and absence of new ones: only a small fraction of focal contrast enhancements measuring up to 1 cm were observed during follow-up (Figure 8).