PMC4921153_01
39-year-old female with lymphoepithelioma-like carcinoma of the right breast. Right mediolateral-oblique (A), craniocaudal (B), and spot magnification craniocaudal (C) digital mammographic projections demonstrate a 2.7-cm, irregular-shaped, high-density mass with microlobulated margins located at the 1 o'clock position at mid depth. Metallic BB markers overlie the nipple and the palpable mass on the mediolateral-oblique and craniocaudal projections.
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A diagnostic mammogram, subsequently performed, revealed a 2.7-cm, irregular-shaped, high-density mass with microlobulated margins at the 1 o'clock position (Fig. 1).
39-year-old female with lymphoepithelioma-like carcinoma of the right breast. Ultrasound images in transverse (A) and longitudinal (B) orientations show a 2.7 x 2.5 x 2.5-cm, nonparallel, irregular-shaped, hypoechoic mass with heterogeneous internal echogenicity, microlobulated margins, and posterior acoustic enhancement. The mass is located at the 1 o'clock position and corresponds to the mammographic mass.
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Right breast ultrasound demonstrated a corresponding 2.7 x 2.5 x 2.5-cm, nonparallel, irregular-shaped, hypoechoic mass with heterogeneous internal echogenicity, microlobulated margins, and posterior acoustic enhancement (Fig. 2).
39-year-old female with lymphoepithelioma-like carcinoma of the right breast. Contrast-enhanced computed tomography axial (A), coronal reformatted (B), and sagittal reformatted (C) images demonstrate an irregular-shaped soft-tissue-density mass with heterogeneous internal enhancement in the right breast upper inner quadrant.
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Computed tomography performed for cancer staging demonstrated an irregular-shaped, heterogeneously enhancing, soft-tissue-density mass in the right breast (Fig. 3) with no evidence of metastatic disease.
39-year-old female with lymphoepithelioma-like carcinoma of the right breast. Ultrasound images in transverse (A) and longitudinal (B) orientations after administration of six cycles of neoadjuvant chemotherapy demonstrate only a small residual area of hypoechogenicity at the site of the primary tumor at the 1 o'clock location (white arrows), indicating an excellent treatment response. An echogenic focus representing the microclip placed at the time of core needle biopsy is also noted (black arrowheads).
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Only a small residual area of hypoechogenicity could be seen on a subsequent ultrasound examination, indicating an excellent treatment response (Fig. 4).
39-year-old female with lymphoepithelioma-like carcinoma of the right breast. Photomicrograph of tissue samples from the wide local excision specimen. Hematoxylin and eosin stain, 20X (A) demonstrates cords of undifferentiated neoplastic cells (arrow) with a prominent lymphocytic stromal infiltrate. Hematoxylin and eosin stain; 40X (B) shows large tumor cells (arrow) with poorly defined cytoplasmic borders, pleomorphic and vesicular nuclei, and nucleoli. Lymphocytic infiltrate is present throughout the tumor. A mitotic figure can be seen in the center of this image (arrowhead). Staining with CAM 5.2; 20X (C) shows neoplastic cells positive for the CAM 5.2 keratin marker. CD3 immunohistochemistry staining; 20X (D) demonstrates infiltrating lymphocytes highlighted by the CD3 marker.
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Microscopic examination revealed poorly defined nests and cords of undifferentiated epithelial cells with a prominent lymphoplasmacytic infiltrate (Figs. 5A, B). Immunohistochemical staining of the neoplastic cells demonstrated positivity for epithelial markers CAM 5.2 (Fig. 5C), HMW, and CK7. The lymphocytes were predominantly CD3-positive (Fig. 5D) with focal CD20 positivity.