PMC8257392_01
Transverse section of a thorax CT scan presenting an 8 mm pulmonary nodule.
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III invasive ductal carcinoma (IDC) ER 100%, PgR negative, HER2 positive (FISH), and Ki67 > 30%, initially managed with neoadjuvant chemotherapy (CHT) with sequential anthracycline/taxane-based regime combined with dual anti-HER2 blockade (trastuzumab/pertuzumab), followed by surgery (cT3N+/ypT2N1(3/15)cM0). In November 2020, the follow-up CT scan (Figure 1) showed bilateral pulmonary nodules.
PET/CT images showing an increased metabolic activity in the pulmonary suspected lesion.
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PET/CT showed abnormal 18F-FDG uptake in the referred suspected pulmonary nodules, without other hypermetabolic changes that may suggest malignant involvement (Figure 2).
Microscopic examination of the basal nodule biopsy specimen (H&E, 40x). Pulmonary parenchyma (upper left corner) with involvement of epithelial cells with the clear cytoplasm and well-defined cell membrane, interspersed within a highly vascularized stroma, compatible with ccRCC. Inside this, a distinct population cells, arranged in nests, with a more eosinophilic cytoplasm is identified, corresponding to the breast carcinoma.
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Microscopic examination (Figures 3 and 4) and immunohistochemical study (Figure 5) of the basal nodule biopsy specimen revealed two distinct neoplasms.
Microscopic examination of the basal nodule biopsy specimen with a high-power field showing the two neoplastic components (H&E, 400x). Note the two mitotic figures on the breast cancer component.
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Microscopic examination (Figures 3 and 4) and immunohistochemical study (Figure 5) of the basal nodule biopsy specimen revealed two distinct neoplasms.
Immunohistochemical stains. (a) (Cam5.2, 200x) Both neoplasms are positive for cytokeratins, confirming an epithelial origin of the two neoplastic populations. (b) (CD10, 200x) Strong and diffuse positivity for CD10, characteristic of ccRCC. Highlight the antibody's negativity in the breast carcinoma cell population. (c) (ER, 200x) Strong and nuclear positivity for the antibody directed to ER in breast carcinoma cells. Highlight the antibody's negativity in the ccRCC component.
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Microscopic examination (Figures 3 and 4) and immunohistochemical study (Figure 5) of the basal nodule biopsy specimen revealed two distinct neoplasms.
Overview of the patient clinical history and management.
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An overview of patient clinical history and management is given in Figure 6.