PMC10134057_01
MMG, ultrasonography, and magnetic resonance images of the right breast. a MMG with a dense breast pattern showed neither tumors nor microcalcifications. b Ultrasonography showed focal hyper-echoes (arrows) and hypo-echoes (asterisks) without distinct tumor formation. c Magnetic resonance images showed multifocal lesions with persistent enhancement.
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F1
Although the patient noticed a right breast mass just before the cytoreductive surgery, MMG showed no abnormalities (Fig. 1a). Ultrasonography showed only admixture of patchy hypo- and hyper-echoes without distinct tumor margins (Fig. 1b). Magnetic resonance imaging (MRI) with contrast medium showed multiple enhanced lesions with persistent enhancement in the right breast (Fig. 1c).
Chest computed tomography (CT) and positron emission tomography (PET). a CT showed massive effusion in the right pleural cavity, neither with pulmonary nodules nor with pleural masses. b PET showed no avidity in the breasts.
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F2
Positron emission tomography (PET)/CT showed no fluorodeoxyglucose uptake in the breasts (Fig. 2a, b).
Pathological findings. a, b Although the largest lesion (arrowheads) are distributed from the bottom to the top of the mammary gland, small nodules (arrows) are located deep in the mammary gland. c Typical signet ring cell carcinomas (arrowheads) formed a cluster. d A large mucous lake (asterisk) was observed in the mammary gland. e D2-40 immunostaining showed lymphovascular invasion (arrows).
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F3
Pathological study of the resected breast showed triple-negative atypical cells similar to the biopsy specimen, mucous lake formation, predominant localization of the metastatic breast tumors deep in the mammary gland, and lymphovascular invasion (Fig. 3a-e).