PMC10332164_01
The pathology and immunohistochemical staining of rectal cancer specimens in the first operation. Show an irregular glandular growth pattern with intraglandular necrotic debris, with a large nucleus, hyperchromatic nuclei, obvious nuclear atypia, cytoplasmic depletion, red staining, and invasive growth. ((A), H&E stain, x100), ((B), H&E stain, x200), Immunohistochemical staining revealed that the rectal cancer cells were positive for CK20 ((C) x100). Upon pathological examination of the breast tumor specimen, malignant cells were observed along with normal breast tissue. The glandular epithelium was found to proliferate into papillary and tubular structures, with large nuclei, with hyperchromatic nuclei, obvious nuclear -atypia, and cytoplasmic depletion. The cells exhibited invasive growth, with no carcinoma in situ component detected. (D, H&E stain, x100), (E, H&E stain, x200), Immunohistochemical staining revealed that the breast tumor cells were positive for CK20 (F x100), CDX-2 (G x100), Villin (H x100), and were negative for GATA-3 (I x100).
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A pathological biopsy confirmed the presence of rectal low-differentiated adenocarcinoma, which was graded as rectal adenocarcinoma stage III (T3N2M0) ( Figure 1 ). Routine pathological showed that the lump we took showed an adeno-tubular arrangement with large nuclei and heteromorphism, which was considered to be an invasive carcinoma, while immunohistochemistry suggested ER(-), PR(-), HER-2(0), GATA-3(-), CDX-2(+), CK20(+), Villin(+), Ki-67(+,70%) ( Figure 1 ).
Large redness and swelling visible in the left breast at the time of presentation.
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A large red swollen area of approximately 15 x 10 cm was observed in the left breast with hard nodules of various sizes scattered around it ( Figure 2 ).
MRI image shows (A, B) enlarged left breast with multiple foci of scattered abnormal enhancement and enlarged lymph nodes in the left axilla, Ultrasound shows (C) thickened subcutaneous soft tissue in the left breast and multiple irregular hypoechoic areas, CT shows (D) uneven thickening and enhancement of the rectal anastomosis wall with small nodules in the adjacent peri-intestinal space.
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Fortunately, the patient's head CT, abdominal ultrasound, and gynecological ultrasound did not reveal any abnormal changes, but the patient strongly refused to undergo the mammogram examination due to her complaint of being unable to tolerate the pain associated with it ( Figure 3 ).
Shows a comparison of abdominal CT images before and after chemotherapy in the patient, and a timeline of the patient's treatment process. (A) displays the image prior to chemotherapy, with enlarged lymph nodes indicated by the arrow. (B) displays the image after three courses of chemotherapy, with the same lymph nodes indicated by the arrow now visibly reduced in size. This visual representation highlights the effectiveness of chemotherapy in reducing the size of the lymph nodes. (C) timeline of the patient's treatment process.
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The patient was last evaluated on February 21, 2023, the patient underwent an abdominal CT scan which showed that several small nodules with a short diameter of less than 1 cm in the adjacent peri-intestinal space were smaller than before, and the enlarged lymph nodes in the left inguinal region, adjacent to the iliac vessels and the retroperitoneum were slightly reduced ( Figure 4 ).