PMC5116944_01
Initial clinical manifestation of the patient. A red nodule located in the left upper side of left breast and several palpable lymph nodes in the homolateral axillary fossa region. Diagnostic ultrasound demonstrates hypoechoic mass and suspicious left axillary lymph nodes at initial presentation (pre-biopsy).
oncoscience-03-268-g001.jpg
PMC5116944_01_oncoscience-03-268-g001.jpg
F1
A red nodule appeared in the left upper side of left breast one month before she came to my clinic (Figure 1), which made her come to our breast cancer center. Ultrosonography for the left breast demonstrated a left-sided hypoechoic mass measuring 3.5 cm and located at the 3 o'clock position adjacent to the nipple-areolar complex, and also revealed suspicious left axillary lymph nodes (Figure 1). Ultrasound-guided biopsy of the breast mass demonstrated an infiltrating ductal carcinoma (IDC) of the left breast with ER+ 90% mild, PR+90% mild, HER2 0, Ki67+ 70% by immunohistochemistry (IHC), luminal B subtype (Figure 2).
Tissue pathological confirmation of the primary mass. Ultrasound-guided core needle biopsy, hematoxylin-eosin (HE) morphological diagnosis and immunohistochemistry examination routinely.
oncoscience-03-268-g002.jpg
PMC5116944_01_oncoscience-03-268-g002.jpg
F2
Ultrosonography for the left breast demonstrated a left-sided hypoechoic mass measuring 3.5 cm and located at the 3 o'clock position adjacent to the nipple-areolar complex, and also revealed suspicious left axillary lymph nodes (Figure 1). Ultrasound-guided biopsy of the breast mass demonstrated an infiltrating ductal carcinoma (IDC) of the left breast with ER+ 90% mild, PR+90% mild, HER2 0, Ki67+ 70% by immunohistochemistry (IHC), luminal B subtype (Figure 2).
Reassessment of the primary tumor after neoadjuvant chemotherapy. Skin red nodule disappeared after 6 cycles of TAC neoadjuvant chemotherapy. Surgical pathology revealed a similar subtype of breast cancer with core needle biopsy before neoadjuvant chemotherapy, though ER, PR and Ki67 staining intensity was not completely consistent, which didn't change the subtype of breast cancer.
oncoscience-03-268-g003.jpg
PMC5116944_01_oncoscience-03-268-g003.jpg
F3
HER2 0, Ki67+ 20%). Histological response to neoadjuvant chemotherapy is grade 3 according to the Miller/Payne grading system (Figure 3).
Cranial computerized tomography (CT). CT revealed the brain metastatic lesion and brain midline shift. There is a slightly high density nodule in the left parietal lobe, and the surrounding is the low density edema before operation, and patchy opacity left there after operation.
oncoscience-03-268-g004.jpg
PMC5116944_01_oncoscience-03-268-g004.jpg
F4
Brain metastatic event appeared in 6 months after mastectomy as firstly presented by terrible headache and intracranial hypertension, which were confirmed by cranial computerized tomography (Figure 4).
Surgical pathology of the brain metastatic lesion. Hematoxylin-eosin (HE) morphologically identified breast cancer metastasis in brain, and immunohistochemistry examination reassessment of the metastatic lesion showed ER+70% mild, PR+70% mild, HER2++, Ki67+ 30%, fluorescence in situ hybridization confirmed HER2 overexpression.
oncoscience-03-268-g005.jpg
PMC5116944_01_oncoscience-03-268-g005.jpg
F5
Final pathology of brain metastasis showed a HER2 overexpression metastatic breast cancer with ER+ 70% mild, PR+ 70% mild, HER2 2+, Ki67+ 30%), FISH confirmed HER2 overexpression (Figure 5).