PMC8437380_01
Pathological results of the breast. Haematoxylin-eosin (H&E) staining of biopsy samples (40x) magnification. (A) Immunohistochemical staining results of breast showed ER 10% (B) and PR 5% (C) and HER-2 2+ (D) and Ki-67 30% (E).
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A needle biopsy of the mass in the left breast was performed on December 18, 2017 and pathological analysis revealed that it was an invasive carcinoma (non-special type III) (Figure 1) that was HER-2 2+, ER 10%, PR 5%, Ki-67 30%, and FISH test positive.
Computed tomography of the chest and breast before treatment. (A) First whole body assessment. Abnormal high-density shadows can be seen on magnetic resonance imaging of the head. (B) Computed tomography before modified radical mastectomy of left breast cancer. (C) Magnetic resonance imaging of the second intracranial mass before surgery. (D) First computed tomography image revealing the hepatic space-occupying lesions. (E) Computed tomography image of the hepatic mass before biopsy (F).
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Therefore, further whole body assessment was performed, and computed tomography (CT) scans of the chest and head (Figure 2A) revealed a mass with abnormal density or shadows in both breasts, with bilateral multiple enlarged axillary lymph nodes and circular low-density plaques with a diameter of about 3 cm in the right frontal lobe. Moreover, because head magnetic resonance imaging (MRI) (Figure 2B) showed that the right frontal lobe was abnormally enhanced and occupied, the possibility of metastasis was considered based on her medical history.Further, needle biopsy of the tumor on the right breast and pathological test results revealed the absence of cancerous tissue. CT scans of the chest (Figure 2C) suggested that the axillary lymph nodes and abnormal mass in the left breast had reduced in size. However, a repeat head MRI showed (Figure 2D) that the right frontal lobe was abnormally enhanced and that it was slightly larger than before. CD34 (vascular endothelium +), ckp (-), GFAP (small part +), and NSE (-), and when combined with morphology, these findings supported a diagnosis of diffuse astrocytoma (WHO grade II). CT imaging of the chest and abdomen performed (Figure 2E) at follow-up on November 23, 2020 revealed expected postoperative changes in the left breast with no obvious abnormal masses or shadows. A whole abdomen enhanced CT on March 11, 2021, revealed (Figure 2F) that the abnormal enhancement of the lobe was about 35x26 mm in size and larger than that seen previously.
Pathological results after breast cancer surgery. Haematoxylin-eosin (H&E) staining of biopsy samples (40x) magnification). (A) Immunohistochemical staining results after breast cancer surgery: ER 10% (B), PR 20% (C), HER-2 2+-3+ (D), Ki-67 40% (E).
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Postoperative pathological results of the initial intracranial space-occupying lesion. Haematoxylin-eosin (H&E) staining of biopsy samples (40x) magnification. (A) Postoperative immunohistochemical staining results of the initial intracranial space-occupying lesion showed GFAP 3+ (B), Ki-67 <5% (C).
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Postoperative analysis of the resected tissue (Figure 4) showed that the tumor cells were small sized, arranged tightly, and localized, with significant proliferation of small blood vessels.
Pathological results of the intracranial space-occupying lesion after the second operation. Haematoxylin-eosin (H&E) staining of biopsy samples (40x) magnification). (A) Immunohistochemical staining results of the intracranial space-occupying lesion after the second operation showed GFAP (small part +) (B), ki-67 (5%, partial 5-10%) (C).
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Postoperative examination of the tissue (Figure 5) showed that the tumor cells were extremely diverse, ie, they were oval, fusiform, or star-shaped, and both sparse or dense with some having less cytoplasm and others having more.
Pathological results of the puncture of the space-occupying liver lesions. Haematoxylin-eosin (H&E) staining of biopsy samples (40x) magnification. (A) Immunohistochemical staining results of the puncture of the space-occupying liver lesions: vimentin + (B), HMB45 + (C), ki-67 15% (D).
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A liver biopsy was performed and pathology reported (Figure 6) that the tissue was relatively fragmented with little liver tissue seen in some areas.
Pathological results of hepatic space-occupying lesions after surgery. Haematoxylin-eosin (H&E) staining of biopsy samples (40x) magnification. (A) Immunohistochemical staining results of hepatic space-occupying lesions after surgery: Melan A + (B), ki-67 10% (C).
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Postoperative pathological report (Figure 7) described the liver structure as destroyed with unclear tumor tissue boundaries and no capsules.