PMC9869869_01
Imaging of the tumor. (A, B) Mammogram showed an irregular high-density shadow posterior to the nipple of the right breast and bilateral axillary lymph nodes were slightly enlarged. (C, D) Ultrasound showed a hypoechoic nodule on the right breast, 0.3 cm from the nipple at 12 o 'clock, 1.7 x 1.4 cm in size. (E, F, G) The patient's PET-CT results in 2019. Hypermetabolic lesions were found in the subpleura of the apical segment of the right upper lobe of the lung, the mediastinal anterior tracheal posterior vena cava lymph nodes and the subpleura of the basal segment of the left lower lobe. (H) Chest computed tomography guided needle biopsy of the left pulmonary nodule was performed. (I, J, K, L) Comparison of pulmonary nodules and mediastinal metastatic lymph nodes before and after the treatment.
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The breast mammography showed ( Figures 1A, B ) abnormal density and calcification behind the right breast papilla, and bilateral axillary lymph nodes were slightly enlarged. Ultrasound of the breast showed ( Figures 1C, D ) insulting hypoechoic nodules. The patient's PET/CT on August 23, 2019 showed ( Figures 1E-G ): 1. The patient underwent needle biopsy of the left pulmonary nodule ( Figure 1H ). After 4 cycles, the left and right lung nodules and mediastinal lymph nodes were basically invisible, and the curative effect was evaluated as CR ( Figures 1I-L ).
The postoperative pathological examination with hematoxylin and eosin (HE) staining and immunohistochemical (IHC) staining of the tumor. (A, B) Microscopically, the ductal cells in the mammary tumor area showed squamous degeneration and the lymph nodes were invaded by tumor cells (20x). (C, D) Histological findings with HE staining showed that the chest wall tumor was a moderately differentiated squamous cell carcinoma and the bone tissue was invaded by tumor cells(20x). (E) Histological findings with HE staining showed that the lung tumor was a metaplastic squamous cell carcinoma(20x). (F-I) IHC staining of the primary tumor in 2015. (F) ER negativity (20x). (G) PR negativity (20x). (H) HER2 receptor negativity (20x). (I) EGFR positive expression (20x). (J) IHC staining of the lung tumor showed that the PD-L1 positive.
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The final pathology showed ( Figures 2A, B ): (Right) Metaplastic carcinoma-squamous cell carcinoma (histological grade III, size 2.5*2.5*1.5cm) is seen in the upper and middle quadrant of the breast, interstitial vascular tumor thrombus (+);cancer metastasis can be seen in axillary lymph nodes (3/21); immunohistochemical showed ( Figures 2F-I ) estrogen receptor (ER) (-), progesterone receptor (PR) (-), human epidermal growth factor receptor 2 (HER2) (-), CK5/6 diffuse (+), CK14 diffuse (+), Ki67 positive rate 80%, P53 positive rate 90%,epidermal growth factor receptor(EGFR)(+), E-cadherin (-), P63 (+), D2-40 (+).After the operation, the patient received further adjuvant chemotherapy and radiation therapy. Postoperative pathology showed ( Figures 2C, D ): (chest wall tumor) moderately differentiated squamous cell carcinoma. The left lung nodule puncture pathology showed( Figures 2E, J ) that the lung tissue had moderately differentiated squamous cell carcinoma infiltration, PD-L1(SP263) positive rate 2%,which was considered to be derived from breast cancer.
Timeline showcasing relevant data from the episode of care. (-): Negative expression; (+): Positive expression. 4 x EC  4 x T: four cycles chemotherapy of epirubicin and cyclophosphamide followed by four cycles of docetaxel. IMRT: intensity modulated radiotherapy. 6 x TP: Six cycles chemotherapy of liposomal paclitaxel and carboplatin. 4 x TP + nivolumab: four cycles chemotherapy of albumin paclitaxel plus cisplatin combined with nivolumab.
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So far, no obvious recurrence or metastasis has been found ( Figure 3 ).