PMC4334635_01
Left breast mass, anterior view at presentation.
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Her left breast was massively enlarged and tender, with a flattened nipple, engorged superficial vessels, and deeply erythematous, partially necrotic skin (Fig. 1).
Transverse ultrasound, 3:00-12:00 axis, demonstrating a large hypoechoic mass (arrows) that extends beyond the field of view and compresses the normal breast parenchyma seen superficially.
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Though mammography could not be performed, ultrasound revealed an enormous heterogeneous mass underlying the left breast and compressing the normal breast tissue anteriorly (Fig. 2).
Scout image from CT of the chest demonstrates large left breast mass.
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A CT-chest scout image clearly showed the large extruding left breast mass (Fig. 3), but abdominal and pelvic CTs showed no evidence of distant disease.
VAC sponge covering left breast/chest wall defect measuring 38 x 28 cm.
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The defect was left open and temporarily sealed with a VAC sponge (Fig. 4).
Left pathology slide shows an intra-canalicular (leaf-like) pattern of growth with periductal variable cellular stroma in CP (100X mag). Right slide shows a high-grade sarcomatous component composed of spindle and giant cells and scattered mitoses (200X mag).
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There was a high nuclear grade and a mitotic index of more than 20 mitoses per 10 HPF (Fig. 5).
Left latissimus myocutaneous flap/left thigh split-thickness skin graft reconstruction of the left breast, 2 years after surgical reconstruction, anterior view.
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Reconstruction of the breast and chest wall defect took place 1 week after the mastectomy with a left latissimus myocutaneous flap and left thigh split-thickness skin graft for additional skin coverage (Fig. 6).