Educational Case: Invasive Ductal Carcinoma of the Breast

Ultrafast MR imaging findings of 2 different subtypes in a male patient with bilateral breast cancer

Bilateral breast cancer in males is an exceedingly rare diagnosis. In this case report, we will discuss the ultrafast sequence findings of a bilateral male breast cancer with different subtypes on his staging dynamic contrast enhanced (DCE) MRI with ultrafast technique. A 94-year-old male presented with bilateral palpable complaints in his breasts. Diagnostic mammography and ultrasound images demonstrated bilateral irregular masses with nipple retraction. Biopsies were performed and the histopathologic examination revealed invasive breast carcinoma of no special type in 1 breast and invasive micropapillary carcinoma in the other breast. Staging MRI with ultrafast sequence showed significant enhancement differences between 2 different subtypes, correlating with the different levels of tumor aggressiveness. Different ultrafast metrics, such as time-to-enhancement and maximum slope, may help to differentiate between several subtypes of breast cancer and serve as prognostic indicators. This case report discusses the application of ultrafast sequence in predicting breast cancer subtypes in a male patient with bilateral disease.

A Rare Presentation of Metastatic Breast Cancer Manifesting As Diffuse Nodular Skin Lesions

We present a 63-year-old African American female with a prior medical history of gastroesophageal reflux disease (GERD) and uterine fibroids whose primary concern was vaginal bleeding. She had no prior medical care established, and the last mammogram was conducted 10 years prior with normal results. She has had multiple ED visits for symptoms of reflux and vaginal bleeding and has been discharged with a primary care follow-up referral each time. On physical exam, there was evidence of nodular skin lesions, tightening of the skin on her face, neck, and back, as well as nodular skin lesions on her neck, back, chest, and abdomen, notably progressing in number, not in size, in a caudal fashion. Further exam findings included telangiectasias predominantly on her right hand. On initial laboratory studies, she was hypercalcemic with an elevated calcium level of 13 mg/dL. Initial imaging included a CT scan of her chest, abdomen, and pelvis, which revealed pulmonary embolism and uterine fibroids, with the largest measuring 5.9 x 4.3 x 5.3 cm, as well as bilateral breast masses noted to be a BI-RADS 3 on ultrasound. A skin biopsy completed early on in the hospitalization revealed metastatic breast cancer, specifically high-grade, poorly differentiated infiltrating mammary carcinoma of the lobular type. Similarly, a right breast mass biopsy illustrated resemblant findings, specifically invasive mammary carcinoma with mixed ductal and lobular features. She was ultimately treated with ribociclib and fulvestrant (KR1) and discharged from the hospital with oncology and primary care follow-up.

Mutations in Structural Genes of the Mitochondrial Complex IV May Influence Breast Cancer

Although it has gained more attention in recent years, the relationship between breast cancer (BC) and mitochondrial oxidative phosphorylation (OXPHOS) is still not well understood. Importantly, Complex IV or Cytochrome C Oxidase (COX) of OXPHOS is one of the key players in mitochondrial balance. An in silico investigation of mutations in structural genes of Complex IV was conducted in BC, comprising 2107 samples. Our findings show four variants (rs267606614, rs753969142, rs199476128 and rs267606884) with significant pathogenic potential. Moreover, we highlight nine genes (MT-CO1, MT-CO2, MT-CO3, CO4I2, COX5A, COX5B, COX6A2, COX6C and COX7B2) with a potential impact on BC.

Educational Case: HER-2 Positive Breast Cancer

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040. ¹