Abstract
Introduction An 81-year-old woman presented with fatigue, nausea, vomiting, 9.1 kg (20 lb) weight loss, and a right lower quadrant abdominal mass. Computed tomography (CT) of the chest, abdomen, and pelvis revealed extensive lytic bony lesions, a left periaortic soft tissue mass, a right intra-abdominal soft tissue mass, a peritoneal mass in the falciform ligament, and bilateral perinephric fat metastasis (Figure 1A, B). Bone scanning revealed diffuse osseous metastasis (Figure 2). The patient underwent a CT-guided biopsy of the periaortic mass. On histologic examination, the tumor was composed of sheets of monomorphic neoplastic cells. The cells were discohesive, with eccentric nuclei and apocrine-like cytoplasm. Immunohistochemistry was performed. The tumor was diffusely positive for cytokeratin (AE 1/3), cytokeratin 7, growth cystic disease fluid protein-15, and estrogen receptor; variably positive for progesterone receptor; and negative for cytokeratin 20 and mammaglobin (Figure 3A, B). This profile is compatible with metastatic lobular
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