PMC4290064_01
Mammography. (a) Cranio-caudal (b) medio-lateral view: Showing a large densely calcified lobulated mass measuring 5 x 3 cm with irregular margins in the upper outer quadrant of the left breast
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F1
In addition, a small noncalcified area was noted in the lower and the medial aspect of the mass [Figure 1a and b].
Computed tomography scan axial view showing the 5 x 3 cm multi lobulated densely calcified extra skeletal mass with a normal lung parenchyma
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F2
A computed tomography (CT) chest done subsequently also confirmed the presence and extent of the multilobulated densely calcified extra skeletal mass with normal lung parenchyma [Figure 2].
(a and b) Breast tissue with adjacent fragment showing malignant osteoid surrounded by ovoid to spindled plump cells with hyperchromatic nuclei and scant cytoplasm along with a few multinucleated giant cells. Mitosis was also noted (H and E, x10). (c) Tumor cells showing immune negative for keratin (immunohistochemistry [IHC], x40). (d) Tumor cells showing immune positive for vimentin (IHC, x40)
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F3
A Tru-cut biopsy was re-attempted from the noncalcified soft tissue component under ultrasound guidance, the histopathology along with immunohistochemistry (IHC) correlation of which (positive for vimentin and negative for keratin, estrogen receptor [ER], proliferation rate [PR] and human epidermal growth factor receptor 2 [HER2neu]) was reported as a malignant tumor with an osteoid matrix, suggestive of a high grade primary breast osteosarcoma [Figure 3a-d].
Technetium 99-methylene diphosphonate bone scintigraphy showing an intense uptake in the left breast corresponding to the primary tumor
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F4
An intense localized uptake in the left breast on a technetium 99-methylene diphosphonate (Tc-99m) bone scintigraphy further corroborated the preoperative diagnosis of primary breast osteosarcoma [Figure 4].
(a and b) Mastectomy specimen showing the tumor excised with wide margins
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F5
The patient was taken up for a definitive radical surgery which in this case entailed a simple mastectomy [Figure 5a and b].