PMC6148982_01
A) Mammography in craniocaudal view at presentation showing diffuse skin and trabecular thickening with no obvious masses. B) Ultrasound images showing large irregular lobulated hypoechoic breast lesions extending to the axilla with increased vascularity and posterior attenuation. C) Enhanced CT scan of the chest showing bilateral heterogeneous infiltrative breast masses extending to the axilla associated with diffuse skin thickening.
asm-37-1-79-g001.jpg
PMC6148982_01_asm-37-1-79-g001.jpg
f1-asm-1-79
The current study showed no obvious masses (Figure 1A). Complimentary breast and axillary ultrasound showed multiple large hypoechoic breast masses (Figure 1B). A CT scan showed bilateral large heterogeneous breast masses extending to the axilla (Figure 1C).
A) Enhanced CT scan of the abdomen showing infiltration of the anterior abdominal wall and small area of the mesentery (arrow). B) Enhanced CT scan of the abdomen showing small infiltration in the retro-peritoneum adjacent to the right psoas muscle (arrow). C) Enhanced CT scan of the abdomen and pelvis showing another area of mesenteric involvement by the disease (arrow). D) Enhanced CT scan of the abdomen and pelvis showing infiltration of the left kidney (arrow). E) Enhanced CT scan of the abdomen and pelvis showing multiple subcutaneous nodules at the perianal region (arrow).
asm-37-1-79-g002.jpg
PMC6148982_01_asm-37-1-79-g002.jpg
f2-asm-1-79
A diffuse infiltrative process involving the subcutaneous tissues was seen in the midline and perianal region (Figure 2A, 2E). Infiltrations of small areas were seen in the retroperitoneum, mesentery and the left kidney (Figure 2B, 2C, 2D).
A) Technetium 99m MDP bone scan showed bilateral symmetrical increased tracer uptake in the distal aspects of the femora and tibiae. B) Complimentary SPECT-CT scan showing bilateral symmetrical sclerosis of the distal Femora with increased tracer uptake.
asm-37-1-79-g003.jpg
PMC6148982_01_asm-37-1-79-g003.jpg
f3-asm-1-79
A whole body bone scan showed bilateral symmetrical increased tracer uptake in the distal part of the femur and tibia (Figure 3A), which correlated to sclerotic bone changes in the corresponding SPECT-CT images (Figure 3B).
A) Histopathology slides in hematoxylin and eosin (H&E) stain and 10-power magnification, showing the characteristic xanthomatous histiocytes (large arrow) and multinucleated Touton type giant cells (small arrow). b. Immunohistochemistry studies showing the CD68 positivity.
asm-37-1-79-g004.jpg
PMC6148982_01_asm-37-1-79-g004.jpg
f4-asm-1-79
The histiocytes were mixed with few small lymphocytes (Figure 4A). In the immunohistochemistry tests, the histiocytes were positive for CD68 and negative for CD1a and S-100 (Figure 4B).
A) Enhanced CT scan of the chest showing nearly complete resolution of the breast lesions. B) Enhanced CT scan of the abdomen and pelvis showing small area of residual infiltration in the retroperitoneum (arrow).
asm-37-1-79-g005.jpg
PMC6148982_01_asm-37-1-79-g005.jpg
f5-asm-1-79
The patient was showing good tolerance and an excellent clinical and radiological response (Figure 5A, 5B).