PMC5521029_01
Diagnostic mammogram: Right mediolateral oblique view showing an irregular high density mass in the right breast, posterior depth, upper region.
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She proceeded to have a diagnostic mammogram (Fig. 1) and ultrasound (Fig. 2) which demonstrated an irregular mass in the right axilla with increased vascularity, highly suggestive of malignancy.
H&E staining on high power field (40x) showing neoplastic cells with nuclear pleomorphism, nuclear molding, mitotic figures, hyperchromatic nuclei, minimal cytoplasm, and indistinct nuclei consistent with the diagnosis of small cell neuroendocrine carcinoma.
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Biopsies revealed small cell carcinoma with neuroendocrine features in both areas (Fig. 3), ER/PR negative, HER2 negative.
Immunohistochemical staining for synaptophysin is positive with objective of 40x.
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Immunohistochemical staining was positive for TTF-1, synaptophysin and chromogranin, suggesting a primary small cell carcinoma of the breast (Fig. 4).
Breast MRI: 4.6 x 6.6 x 6.3 cm irregular mass in the right axilla with multiple oval masses in the right axillary tail consistent with pathological lymph nodes.
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Subsequent MRI (Fig. 5) revealed a 4.6 x 6.6 x 6.3 cm irregular mass in the right axilla with multiple oval masses in the right axillary tail just medial to the larger mass.