PMC7154267_01
Local findings. a Before treatment, multiple satellite skin lesions and skin edema were observed. b After chemotherapy, satellite skin lesions regressed markedly, but skin edema and pigmentation were still observed. c After radiotherapy, slight skin pigmentation was still observed, but almost all of the satellite skin lesions had disappeared. d Ten months after operation, a vertical rectus abdominis muscle flap covered the large skin defect and offered favorable cosmetic outcome.
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F1
A 42-year-old woman with huge mass and skin thickening in her left breast (Fig. 1a) was referred to our hospital. Primary chemotherapy resulted in a marked regression of the breast tumor (Fig. 1b) and complete remission of the regional nodes. Therefore, radiotherapy (48 Gy, 24 fractions) was applied to the whole breast to eradicate cancer cells in the skin, leading to further improvement of the skin edema (Fig. 1c). The patient has received aromatase inhibitor with luteinizing-hormone-releasing hormone agonist and has been well without any recurrence for more than 7 years (Fig. 1d).
Ultrasound images. a Before treatment, marked skin thickening with obscured breast mass was observed. b After chemotherapy, although skin thickening was still observed, a marked shrinkage of the breast tumor (yellow arrow) was observed. c Before treatment, enlarged and oval axillary lymph nodes (white arrow) were observed. d After chemotherapy, markedly regressed lymph nodes (red arrow) were observed.
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F2
Ultrasonography showed marked skin thickening with obscured breast mass (Fig. 2a) and enlarged axillary lymph nodes (Fig. 2c).
Pathological findings. a Marked fibrosis and no viable cancer cells were observed on HE staining of the tumor (x40). b Isolated and atypical cells were observed on cytokeratin AE1 + 3 staining (x100) of the skin near the nipple-areolar complex.
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F3
Pathological examination showed negative surgical margin and no viable cells both in the breast and lymph nodes (Fig. 3a) but cytokeratin AE1 + 3-positive imperceptible cells in the resected skin (Fig. 3b).