PMC5834314_01
Increased FDG uptake on PET CT including uptake in uterus. PET CT scan. 1. Interval increase in FDG uptake of multiple hypermetabolic osseous metastases throughout the axial and proximal appendicular skeleton. 2. Mildly increased FDG uptake of mildly hypermetabolic mediastinal lymph nodes. 3. Moderate FDG uptake of the uterus centrally that was not present on imaging performed ten months prior.
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PET CT scan demonstrated progression of the disease in her bone (axial and proximal appendicular skeleton) and mediastinal lymph nodes and moderate fluorodeoxyglucose (FDG) uptake of the uterus centrally that was not present on imaging performed ten months prior (Figure 1).
Breast metastasis in uterus corpus, endometrium and myometrium. Low-power image of uterus. There are sheets of neoplastic cells replacing the endometrial stroma and intersecting between muscle fibres of the myometrium (arrow). The tumour extended through the entire thickness of the myometrium to the uterine serosa. Cervical and adnexal involvement was also present. On high power (inset), the cells display areas of a classic invasive lobular carcinoma growth pattern, with single-filing of cells readily observed (arrowhead).
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The intra-operative findings were notable for a large friable polypoid mass filling the endometrial cavity and pathologic examination of the endometrial mass revealed metastatic breast cancer (Figures 2 and 3).
Cellular classification of tumour with immunohistochemistry. A high-power image of the tumour cells (a) shows abundant intracellular mucin displacing the nucleus to the periphery of the cell, imparting a 'signet ring' appearance. This feature was also noted in the prior axillary specimen. The tumour cells are strongly positive for GATA3 (b) and mammoglobin (c), two markers of breast origin, while the adjacent endometrium is negative. The cells do not stain for Pax-8 (d), a marker of Mullerian origin, while the intervening endometrium serves as a strong positive control. Additionally, approximately 1-10% of the tumour cells showed weak ER staining and less than 1% were positive for PR (not shown).
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The intra-operative findings were notable for a large friable polypoid mass filling the endometrial cavity and pathologic examination of the endometrial mass revealed metastatic breast cancer (Figures 2 and 3).