PMC8077598_01
Physical and ultrasonography findings. a Physical examination during the patient's visit revealed an elevated lesion with blue purpura around the nipple in the right breast. b We performed breast ultrasound and detected a well-defined 19.6 x 16.4 x 10.7 mm hypoechoic tumor in the left subareolar area. c Blood flow rich.
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F1
Physical examination during her visit revealed an elevated lesion with blue purpura around the nipple in the right breast (Fig. 1a). We performed breast ultrasound and detected a well-defined 19.6 x 16.4 x 10.7 mm hypoechoic tumor in the left subareolar area (Fig. 1b, c).
Pathological findings of the core needle biopsy (CNB) specimen. a, b Following hematoxylin and eosin staining of the CNB specimen, we detected a high-grade necrosis and a high nuclear-cytoplasmic ratio in the tumor cells (a x100; b x400). c Immunohistochemical analysis revealed the CNB specimen to be cytokeratin (CK) 7, CK20, gross cystic disease fluid protein, estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 negative; expression of Ki-67 was high (c x200).
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F2
Following hematoxylin and eosin staining of the CNB specimen, we detected a high-grade necrosis and a high nuclear-cytoplasmic ratio in the tumor cells (Fig. 2a, b). Immunohistochemical analysis revealed the CNB specimen to be cytokeratin (CK) 7, CK20, gross cystic disease fluid protein (GCDFP), ER, PgR and HER2 negative; expression of Ki-67 was high (Fig. 2c).
Macro- and microscopic diagnosis of the resected specimen. a A dark-red tumor sized 18.0 x 12.0 mm was found in a specimen from the nipple. b The pathological diagnosis of the specimen revealed short spindle-shaped tumor cells with strong nuclear pleomorphism and a significant interstitial fibrosis (x200). Immunohistochemistry was performed, and the tumor cells were found to be vimentin positive and AE1/AE3, cytokeratin (CK) 7, CK20, gross cystic disease fluid protein, estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 negative; expression of Ki-67 was high. c Immunohistochemistry using D2-40 (x200) and CD31 antibodies showed irregular luminal proliferation at the anastomosis.
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F3
A dark-red tumor sized 18.0 x 12.0 mm was found in a specimen from the nipple (Fig. 3a). The pathological diagnosis of the specimen revealed short spindle-shaped tumor cells with strong nuclear pleomorphism and a significant interstitial fibrosis (Fig. 3b). D2-40 and CD31 antibodies showed irregular luminal proliferation at the anastomosis (Fig. 3c), infiltration into the surrounding tissue, and massive necrosis, thereby leading to the diagnosis of breast angiosarcoma. During the postoperative follow-up period, when no treatment was provided, recurrence was not observed for 6 months after the surgery.