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High power view of left axillary lymph node biopsy.
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An ultrasound guided core biopsy of the left axillary lymph nodes found metastatic lobular carcinoma with signet ring cell features (Fig. 1).
MRI imaging displaying prominent left axillary lymph nodes as well as right breast lesion.
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A breast MRI revealed a 2 cm irregularity in the lateral right breast as well as multiple left axillary lymph nodes with enhancement in the region of the biopsied lymph node (Fig. 2).
High power view of right breast specimen displaying infiltrating lobular carcinoma.
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A second look right breast ultrasound confirmed the MRI abnormality and a subsequent ultrasound-guided biopsy revealed moderately differentiated invasive lobular carcinoma with signet ring cells, ER/PR positive, Her2 negative, and Ki-67 was 20%, consistent with the contralateral lymph node metastasis (Fig. 3).