PMC7394736_01
(A) Ultrasound findings at first presentation - vascularized and heterogenous nodule in left breast, compatible with cavernous hemangioma. (B) Ultrasound image one year after first appointment: solid, hypervascularized, retroareolar, 16 x 14 x 16 mm mass. (C) Ultrasound image four years after second ultrasound: solid, regular, homogeneous, well delimitated and hypoechoic 27 x 24 x 19 mm mass in the retroareolar region.
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At the time, an ultrasound showed a vascularized and miscellaneous nodule in the mammary region, compatible with cavernous hemangioma (Fig. 1A). A year later, despite no clinical changes, a new ultrasound scan, requested by the same service, showed a solid, 16 x 14 x 16 mm, hypervascularized, retroareolar mass (Fig. 1B). Ultrasound imaging revealed a solid, regular, homogeneous, well delimitated and hypoechoic mass, measuring, in the retroareolar region (Fig. 1C).
(A) Hematoxylin and eosin stain, 10X - tumor exhibiting microcyst architecture with intraluminal eosinophilic secretions. (B) Hematoxylin and eosin stain, 40X - The neoplastic cells are large and polygonal and show eosinophilic and foamy cytoplasm, vesicular chromatin nuclei and evident nucleoli. (C) Periodic acid-Schiff stain (PAS), 10X - Secretory materials are positive for PAS.
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Histological sections showed a cystic tumor with microcystic, tubular and papillary architecture, and intraluminal eosinophilic secretions, positive for periodic acid-Schiff (PAS) stain (Fig. 2).
(A) On immunohistochemistry, the neoplasm was positive for GCFDP-15, (B) S-100 and (C) EMA (epithelial membrane antigen); weak and patchy for (D) estrogen and (E) progesterone receptors (nuclear stain). (F) HER2/neu (c-erbB2) was completely negative (score IHC = 0) and (G) Ki67 index was low (<15%).
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Immunohistochemical analysis demonstrated tumor cells with positive expression for S-100, GCDFP-15 and weak and patchy expression for estrogen and progesterone receptors (Fig. 3A-D). EMA (epithelial membrane antigen) was strongly positive (Fig. 3C). Ki-67 (MIB1) labeling index was low, with less than 15% positive neoplastic cells (Fig. 3E and F). (epithelial Molecular tests were not available.
Mammary gland excision.
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Thus, the patient underwent a left mastectomy (Fig. 4) with sentinel lymph node biopsy (Fig. 5A and B), which was free from malignancy.