PMC9791177_01
(A, B) CT showed high-density masses located in the lateral upper quadrant of the left breast. (C) Non-special type of invasive breast cancer. Immunohistochemistry showed that malignant cells are positive for ER (D) but negative for Syn (E).
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Computed tomography (CT) scans showed that nodules focus in the left breast with blurred margins and marked enhancement (Figures 1A, B). Microscopically, tumor 1 was a non-special type of invasive breast cancer, histologically grade 2 (Figure 1C). Immunohistochemistry in tumor 1 showed that these malignant cells were positive for estrogen receptor (ER) but negative for synaptophysin (Syn) (Figures 1D, E).
(A) Invasive carcinoma of the breast with signet ring feature. Immunohistochemistry showed abnormal cells are positive for ER (B), HER-2 (C), Syn (D), E-cadherin (E), but negative for PAS (F).
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Meanwhile, many tumor cells contained eccentric, clear paranuclear vacuoles resembling signet ring cells (Figure 2A). At the same time, immunohistochemistry in tumor 2 showed that these malignant cells were positive for ER (Figure 2B) and GATA binding protein 3 (GATA-3) but negative for epidermal growth factor receptor (EGFR) and cytokeratin 5/6 (CK5/6). HER-2 status was 2+ (Figure 2C) and fluorescence in situ hybridization (FISH) demonstrated heterogeneity in HER-2 gene amplification in this tumor tissue (Figure 3A). Syn and E-cadherin immunopositivity were on the tumor membranes (Figures 2D, E). Special staining for periodic acid-Schiff stain (PAS) was negative (Figure 2F).
(A) HER-2 detection by FISH, HER-2/CEP17>2.0. (B) Electron microscopy shows aggregation of numerous neurosecretory granules (black arrows) and intermediate filaments (white arrows).
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HER-2 status was 2+ (Figure 2C) and fluorescence in situ hybridization (FISH) demonstrated heterogeneity in HER-2 gene amplification in this tumor tissue (Figure 3A). Electron microscopy confirmed that the neurosecretory granules in the cytoplasm were clustered or locally distributed with intermediate filament aggregation (Figure 3B).