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Koh S, Koi Y, Tajiri W, Kawasaki J, Akiyoshi S, Nakamura Y, Koga C, Okamoto T, Taguchi K, Tokunaga E. Bilateral breast metastases from anaplastic lymphoma kinase-positive lung cancer in a male: a case report. J Med Case Rep 2024; 18:402. [PMID: 39218906 PMCID: PMC11367847 DOI: 10.1186/s13256-024-04707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Distant metastases from lung cancer are commonly found in the brain, bone, and liver. Metastases to the breast from non-mammary malignancies are extremely rare, and their clinical presentations remain unclear. CASE PRESENTATION We herein report a case of bilateral breast metastases from anaplastic lymphoma kinase-positive advanced lung cancer in a 51-year-old Japanese male patient. During the course of systemic treatment for advanced lung cancer, computed tomography revealed bilateral breast enlargement without contrast enhancement, a finding consistent with gynecomastia. While other metastatic lesions responded to chemotherapy, both breast masses grew vertically like nodules. The breast masses were immunohistochemically diagnosed as metastases from lung cancer and were removed surgically. Simultaneous bilateral breast metastases from malignancies of other organs, like ones in this case, have rarely been described. CONCLUSIONS It is important to keep in mind that breast metastases from nonmammary malignancies are a possible explanation for unusual breast findings in a patient with a history of malignancies.
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Affiliation(s)
- Sumire Koh
- The Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, Fukuoka, 807-8556, Japan
| | - Yumiko Koi
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Wakako Tajiri
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Junji Kawasaki
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Sayuri Akiyoshi
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Yoshiaki Nakamura
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Chinami Koga
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Tatsuro Okamoto
- Department of Thoracic Oncology, NHO Kyushu Cancer Center, Fukuoka, Japan. 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Kenichi Taguchi
- Department of Pathology, NHO Kyushu Cancer Center, Fukuoka, Japan. 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan
| | - Eriko Tokunaga
- Department of Breast Oncology, NHO Kyushu Cancer Center, 3-1-1 Notame, Fukuoka-City, Fukuoka, 811-1395, Japan.
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2
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Özşen M, Tolunay S, Polatkan SAV, Senol K, Gokgoz MS. Metastatic Neoplasms to the Breast. Int J Surg Pathol 2024; 32:875-883. [PMID: 37899598 PMCID: PMC11295425 DOI: 10.1177/10668969231201415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE When the clinical presentation is related to the metastatic mass and a radiologically solitary tumor focus is detected, especially in cases where clinical information is not taken into account or is insufficient, if a possible metastatic neoplasia is not kept in mind then it is possible to evaluate the tumor as a primary breast neoplasm. In this study, it is aimed to present our cases of non-hematopoietic metastatic neoplasms and to evaluate the clinicopathological features that may aid in distinguishing metastatic from primary neoplasms. MATERIAL AND METHODS This study includes cases diagnosed with metastatic non-hematopoietic breast neoplasm in breast resection materials in our center, between the years 2010-2023. All cases were analyzed retrospectively by evaluating clinicopathological features. RESULTS Of the 15 subjects included in the study, 11 (73%) were female and 4 (27%) were male. The mean age of the patients were 46.9 ranged from 22 to 63 years. The most frequent metastatic malignancy was carcinoma (60%), followed by melanoma (33%) and sarcoma (7%). Of the 9 patients with metastatic carcinoma, the primary tumor originated from the lungs in 4, from gastrointestinal system in 2, female genital tract in 2, and kidney in 1 patient. Sarcoma diagnosis was given in a single patient and the histology was a leiomyosarcoma originating from kidney. CONCLUSION A careful histomorphological and immunohistochemical evaluation and a detailed examination of the clinicoradiological data are critical to establish the right course in patient management, treatment plan and to correctly predict the prognosis.
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Affiliation(s)
- Mine Özşen
- Department of Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Sahsine Tolunay
- Department of Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | - Kazım Senol
- Department of General Surgery, Uludag University Faculty of Medicine, Bursa, Turkey
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3
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Bendimya M, Kairouani M, El Magroud M, Bennani A, Al Jarroudi O, Brahmi SA, Afqir S. Unusual Metastasis of Gastric Signet Ring Cell Carcinoma to the Breast: A Case Report of a Young Moroccan Patient. Cureus 2024; 16:e56333. [PMID: 38629003 PMCID: PMC11021129 DOI: 10.7759/cureus.56333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Although gastric cancer is known to be an aggressive tumor that can spread throughout the body, breast metastases are uncommon. This entity is rarely reported in the literature, with an estimated incidence of 0.5 to 1.3%. We report a case of a rare association between a gastric subtype of signet ring cell carcinoma and metastasis to the breast. This uncommon situation is only documented through case reports. Most breast metastases have been detected after diagnosis of primary gastric cancer, during the first year. Several risk factors have been suggested to explain the aggressive behavior of these tumors, which correlates with very poor prognosis and short survival. We report the case of a 22-year-old female patient presenting with widespread metastatic gastric signet ring cell carcinoma with an unusual secondary site in the breast. The diagnosis was confirmed by immunohistochemistry (IHC) and radiology, and the patient was treated with palliative chemotherapy in accordance with the decision of the multidisciplinary tumor board.
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Affiliation(s)
- Mohammed Bendimya
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | - Mouna Kairouani
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | | | - Amal Bennani
- Anatomopathology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
| | - Ouissam Al Jarroudi
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | - Sami Aziz Brahmi
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
| | - Said Afqir
- Medical Oncology, Faculty of Medicine and Pharmacy of Oujda, Oujda, MAR
- Medical Oncology, Mohammed VI University Hospital, Mohammed First University of Oujda, Oujda, MAR
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4
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Yu C, Wan D, Zhang Y. Metastatic ovarian serous carcinoma of the breast: A case report. Asian J Surg 2023; 46:5525-5526. [PMID: 37541891 DOI: 10.1016/j.asjsur.2023.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Chunlan Yu
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, 637000, Nɑnchonɡ, China; Department of Pathology, The First People's Hospital of Zigong, 643099, Zigong, China
| | - Dan Wan
- Department of Pathology, The First People's Hospital of Zigong, 643099, Zigong, China
| | - Yutao Zhang
- Department of Pathology, The First People's Hospital of Zigong, 643099, Zigong, China; Department of Pathology, Affiliated Hospital of North Sichuan Medical College, 637000, Nɑnchonɡ, China.
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5
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Tran TL, Tsai I, Choi HW. Solitary Metastasis to the Breast From Thigh Myxoid Liposarcoma. Cureus 2023; 15:e45559. [PMID: 37868406 PMCID: PMC10586712 DOI: 10.7759/cureus.45559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Metastasis to the breast from non-mammary malignancies are rare and suggestive of advanced disease. Accurate and prompt diagnosis of breast metastasis can provide important prognostic information and guide treatment planning. Interestingly, in contrast to primary breast malignancies, non-mammary metastatic breast lesions often have benign-appearing imaging characteristics. Knowing a patient's clinical history and having prior breast imaging studies for comparison is important for making accurate assessments and appropriate recommendations. Imaging-guided biopsy is often indicated for definitive tissue diagnosis. We report a rare case of solitary metastasis to the breast from thigh myxoid liposarcoma.
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Affiliation(s)
- Thuy-Linh Tran
- School of Medicine, University of California, Irvine, Orange, USA
| | - Irene Tsai
- Department of Radiological Sciences, University of California, Irvine, Orange, USA
| | - Hyung Won Choi
- Department of Radiological Sciences, University of California, Irvine, Orange, USA
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6
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Sellers CM, Ortiz-Perez T, Dhamne S, Roark A, Gilman L. Intramammary Metastases from Extramammary Malignancies: An Update. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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7
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Huayanay Espinoza JL, Mego Ramírez FN, Guerra Miller H, Huayanay Santos JL, Guelfguat M. A Spectrum of Metastases to the Breast: Radiologic-Pathologic Correlation. JOURNAL OF BREAST IMAGING 2023; 5:209-229. [PMID: 38416928 DOI: 10.1093/jbi/wbac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Indexed: 03/01/2024]
Abstract
Metastases to the breast from non-mammary origin are rare. The majority of these lesions appear as secondary manifestations of melanoma and lymphoma, followed by lung carcinomas, gynecological carcinomas, and sarcomas. There has been a steady trend of an increase in diagnosis of intramammary metastases owing to the current advances in imaging technology. Imaging features depend on the type of primary neoplasm and route of dissemination, some of which resemble primary breast cancer and benign breast entities. There are certain imaging features that raise the level of suspicion for metastases in the correct clinical context. However, imaging manifestations of intramammary metastases do not always comply with the known classic patterns. The aim of this review is to clarify these features, emphasizing radiologic-pathologic correlation and a multidisciplinary approach, since most cases are found in patients with advanced disease.
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Affiliation(s)
| | | | - Henry Guerra Miller
- Instituto Nacional de Enfermedades Neoplásicas, Department of Pathology, Lima, Peru
| | | | - Mark Guelfguat
- Jacobi Medical Center, Department of Radiology, Bronx, NY, USA
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8
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Erdoğan Ö, Balci MF, Özgüzer A, Özdaş E, Görgülü G, Sanci M. Metastasis of endometrial cancer to breast: A rare case. J Obstet Gynaecol Res 2023; 49:1452-1455. [PMID: 36828642 DOI: 10.1111/jog.15621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023]
Abstract
Only 2% of all breast cancers are metastatic, making them extremely uncommon. They are frequently mistaken for a primary breast tumor. Although it has been observed, metastatic spread from primary uterine cancers is extremely uncommon. In the literature, our case represents the fourth endometroid adenocarcinoma metastasis from the uterus. Clinical, pathological, and immunohistochemical examination and management of metastatic endometrioid adenocarcinoma of the uterus' extragenital organ were described in this 69-year-old patient's case. Immunohistochemical analysis was performed on a breast biopsy taken from the patient who underwent therapy and discovered a breast mass two years later. Metastatic endometrial adenocarcinoma was diagnosed with negative signs pointing to mammaglobin, GCDFP-15 and GATA3 breasts and markers indicating endometroid adenocarcinomas such as p53, PAX8 and VIMENTIN support. As a result, a thorough clinical history is needed, with special attention to diagnoses of concurrent or prior malignancies, along with clinical examination, appropriate radiological evaluation, and immunohistochemistry. This is necessary to prevent unnecessary surgery, to provide appropriate systemic treatment, to ensure correct diagnosis, and to manage treatment.
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Affiliation(s)
- Özgür Erdoğan
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mücahit Furkan Balci
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Alp Özgüzer
- Department of Pathology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Emel Özdaş
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Gökşen Görgülü
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
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9
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Choo ALE, Sim LSJ, Sittampalam K, Tan WC, Tay AZE, Nadarajah R, Tan VKM, Sim Y. Breast metastasis from endometrial clear cell carcinoma: A case report and review of the literature. Front Oncol 2023; 12:1070744. [PMID: 36761429 PMCID: PMC9905423 DOI: 10.3389/fonc.2022.1070744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
Metastasis to the breast from extra-mammary malignancies are rare, accounting for less than 1% of all breast cancers. Endometrial cancer, a common gynecological malignancy, often spreads to the pelvis, abdominal lymph nodes, peritoneum or the lungs. Endometrial metastasis to the breast is extremely rare, and while there have been isolated case reports of endometrial serous carcinoma with breast metastasis, it has not been reported in the case of clear cell carcinoma. We present a rare case of a 70 year old Chinese lady who had a metastatic endometrial clear cell carcinoma with metastasis to the breast, mimicking an inflammatory breast cancer clinically. We reviewed the current literature and describe the challenges in differentiating primary from metastatic breast lesions, as well as clinical, radiological and histopathological features that may help to differentiate the two. Tumour metastasis to the breast via lymphatic or hematogenous route can affect their radiological features: the former mimicking inflammatory breast cancer and the latter with features similar to benign breast lesions. Regardless, histological features with immunohistochemical staining is still the gold standard in diagnosing metastatic breast lesions and determining their tissue of origin. Breast metastases from extra-mammary malignancies are uncommon and it is even rarer for endometrial clear cell carcinoma to spread to the breast. Nonetheless, this case highlights the importance of keeping an open mind and engaging a multidisciplinary team for the care of complex patients.
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Affiliation(s)
- Amadora Li En Choo
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore,*Correspondence: Amadora Li En Choo,
| | | | - Kesavan Sittampalam
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Amos Zhi En Tay
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Ravichandran Nadarajah
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore
| | - Veronique Kiak Mien Tan
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore,Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Breast Centre, Singapore, Singapore
| | - Yirong Sim
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore,Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Breast Centre, Singapore, Singapore
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10
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Musa A, Joiner M, Dzul S, Miller SR. Metastatic spread of serous ovarian carcinoma to the bilateral breasts: a rare presentation. BMJ Case Rep 2022; 15:e251721. [PMID: 36423949 PMCID: PMC9693663 DOI: 10.1136/bcr-2022-251721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/25/2022] Open
Abstract
A woman presented with a mass in her right breast. She had previously been treated with carboplatin, paclitaxel and bevacizumab for serous ovarian carcinoma diagnosed 5 years previously and was currently on maintenance olaparib. A right breast mammogram demonstrated periareolar skin thickening and the physical examination revealed an erythematous, non-blanching cutaneous lesion. A punch biopsy revealed high-grade serous carcinoma of ovarian origin, positive for PAX-8, WT-1 and p53. Positron emission tomogram-CT scan showed diffusely increased fluorodeoxyglucose uptake in the right breast. She was treated with external beam radiation therapy to the right breast and regional lymphatics and received 5200 cGy in 20 fractions to the right breast and supraclavicular region with good response. Two weeks after completing radiation therapy, she presented with a new lesion inferior to her left areola, concerning for metastasis to the contralateral breast. Subsequent biopsy of the left breast identified metastatic serous ovarian carcinoma for which she received an additional 5200 cGy in 20 fractions to the breast.
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Affiliation(s)
- Arif Musa
- Oncology, Wayne State University, Detroit, Michigan, USA
| | - Michael Joiner
- Oncology, Wayne State University, Detroit, Michigan, USA
| | - Stephen Dzul
- Oncology, Wayne State University, Detroit, Michigan, USA
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11
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Zhao R, Xing J, Gao J. Breast Metastasis of Lung Cancer After Computed Tomography-Guided Core Needle Biopsy: A Case Report. Front Surg 2022; 9:890492. [PMID: 35558388 PMCID: PMC9086487 DOI: 10.3389/fsurg.2022.890492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Needle tract metastasis is a rare complication following percutaneous procedures for malignancy. Case Summary This report describes a 49-year-old female with a lump on her right breast. Mass core needle biopsy showed the specimen was an invasive carcinoma, and mastectomy with sentinel lymph node biopsy was performed. What is special about this case was that the patient reported a history of lung cancer and the position of the breast mass was the puncture site of computed tomography-guided core needle biopsy for lung cancer. Immunostaining of paraffin specimen findings indicated the breast mass as a result of lung carcinoma metastasis. The patient's medical history indicated that the malignant tumor in the breast was a core needle tract pulmonary metastasis. The patient underwent the examination and received therapy based on the lung cancer metastasis principle. At 9 months from breast surgery, the patient is alive, in good condition, and with stability of the disease. Conclusions This patient was misdiagnosed. Careful medical history review and multidisciplinary team discussions are important, especially for patients with a history of cancer or invasive operation.
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Affiliation(s)
| | | | - Jinnan Gao
- Department of Breast Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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12
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Zhou P, Chang N, Abraham SC, Albarracin CT, Huo L, Chen H, Ding Q, Resetkova E, Middleton LP, Sahin AA, Bu H, Wu Y. Metastatic non-Hematopoietic Neoplasms to the Breast: A Study of 238 Cases. Hum Pathol 2022; 125:59-67. [PMID: 35447141 DOI: 10.1016/j.humpath.2022.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/05/2023]
Abstract
AIMS The aim of this study was to review the clinicopathologic characteristics of metastatic non-hematopoietic malignancies to the breast, in order to identify salient features for practicing pathologist that are useful in distinguishing metastatic lesions from primary breast neoplasms. METHODS AND RESULTS A total of 238 cases were identified during the period from January 2005 to January 2015. Clinicopathologic features of these cases were retrospectively reviewed. Primary tumors included melanoma (99, 42%), serous carcinoma (35, 15%), neuroendocrine neoplasm (32, 13%), sarcoma (23, 10%), and adenocarcinoma from various organs (47, 20%), among others. Most metastases were unilateral (223, 94%) and unifocal (206, 87%), and were detected radiographically (167, 70%). Concurrent ipsilateral axillary metastasis occurred in 33 (14%) patients. Among 238 cases, 41 had metastatic disease to the breast concurrently or preceding the primary cancer diagnosis. Notable, in 39 (16%) cases, breast metastasis was the first clinical presentation of disease, and 16 (41%) of these cases were initially misdiagnosed as breast primaries. In contrast, with known history of non-mammary primary tumors, only 4 of 197 (2%) cases were misdiagnosed (p<0.0001). CONCLUSIONS Metastatic tumors share many overlapping features with breast primary carcinomas. However, cases with a well-circumscribed tumor, lack of in situ component, ER/PR negativity, and unusual morphologic features should raise the consideration of metastatic disease. While clinical history is paramount for correct diagnosis, metastasis to the breast as the first clinical presentation is not uncommon.
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Affiliation(s)
- Ping Zhou
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Pathology, West China 4(th) Hospital, Sichuan University
| | - Nina Chang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Susan C Abraham
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Constance T Albarracin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Huo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Chen
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qingqing Ding
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erika Resetkova
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lavinia P Middleton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aysegul A Sahin
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hong Bu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Wu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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13
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Shen T, Zhao J, Zhao M, Taggart MW, Ramalingam P, Gong Y, Wu Y, Liu H, Zhang J, Resetkova E, Wang WL, Ding Q, Huo L, Yoon E. Unusual Staining of Immunohistochemical Markers PAX8 and CDX2 in Breast Carcinoma: A Potential Diagnostic Pitfall. Hum Pathol 2022; 125:35-47. [DOI: 10.1016/j.humpath.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
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14
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Yoon E, Ding Q, Hunt K, Sahin A. High-Grade Spindle Cell Lesions of the Breast: Key Pathologic and Clinical Updates. Surg Pathol Clin 2022; 15:77-93. [PMID: 35236635 DOI: 10.1016/j.path.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Most of the high-grade spindle cell lesions of the breast are malignant phyllodes tumors (MPTs), spindle cell carcinomas (SpCCs), and matrix-producing metaplastic breast carcinomas (MP-MBCs). MPTs have neoplastic spindle stromal cells and a classic leaf-like architecture with subepithelial stromal condensation. MPTs are often positive for CD34, CD117, and bcl-2 and are associated with MED12, TERT, and RARA mutations. SpCCs and MP-MBCs are high-grade metaplastic carcinomas, whereas neoplastic epithelial cells become spindled or show heterologous mesenchymal differentiation, respectively. The expression of epithelial markers must be evaluated to make a diagnosis. SAS, or rare metastatic spindle cell tumors, are seen in the breast, and clinical history is the best supporting evidence. Surgical resection is the standard of care.
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Affiliation(s)
- Esther Yoon
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA.
| | - Qingqing Ding
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
| | - Kelly Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 85, Room G1.3565C, Houston, TX 77030-4009, USA
| | - Aysegul Sahin
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston TX 77030-4009, USA
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15
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Metastatic melanoma in the breast and axilla: A case report. Clin Imaging 2022; 85:78-82. [DOI: 10.1016/j.clinimag.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 11/24/2022]
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16
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Bannon M, Marak C, Ashraf A, Smith C, Nunley M, Guddati AK, Kaushik P. Unusual presentation of a small cell lung cancer with bilateral breast metastases: Case report and a brief review of the literature. Respir Med Case Rep 2022; 38:101693. [PMID: 35799863 PMCID: PMC9254160 DOI: 10.1016/j.rmcr.2022.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Small cell lung cancer (SCLC) is a smoker's disease and occurs almost exclusively in smokers. SCLC is a high-grade neuroendocrine tumor and commonly presents as a central tumor with bulky mediastinal adenopathy. It is notorious for causing widespread disease and paraneoplastic syndromes. The usual sites of metastasis include the liver, brain, bone, and adrenals. SCLC presenting with breast metastasis is unusual; however, there are reports of unilateral and bilateral breast metastases. SCLC with bilateral breast metastases is extremely rare, with only five previously reported cases available in the literature. We are taking this opportunity to report and add to the growing literature on the unusual presentation of a small cell lung cancer with bilateral breast metastases.
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Shah VI, Morgan SE, Köbel M, Lee CH, McCluggage WG. Dedifferentiation in Breast Metastasis of Endometrial Carcinoma: A Diagnostic Dilemma. Int J Gynecol Pathol 2022; 41:35-39. [PMID: 33741764 DOI: 10.1097/pgp.0000000000000770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most breast tumors are primary to this site; breast metastasis of endometrial origin is extremely rare. Low-grade endometrioid endometrial carcinomas can undergo dedifferentiation to undifferentiated carcinoma but such transformation at a metastatic site has been reported previously in only 2 cases. We report a case of dedifferentiation occurring in an isolated solitary breast metastasis of a low-grade endometrioid endometrial carcinoma. A 64-yr-old woman presented with a breast mass 2 yr after initial diagnosis of a grade 1 FIGO stage IIIA endometrioid endometrial carcinoma. Ultrasound guided biopsy of the breast mass showed a grade 1 endometrioid carcinoma which was diffusely estrogen receptor and PAX8-positive, consistent with metastasis from the previous endometrial carcinoma. The tumor initially responded to Letrozole therapy but then abruptly increased in size. Mastectomy revealed a poorly differentiated malignant tumor with morphology and immunophenotype (including loss of ARID1A and ARID1B immunoreactivity) consistent with undifferentiated endometrial carcinoma with no residual low-grade component. Awareness of the phenomenon of dedifferentiation of endometrial carcinoma in a metastatic site is important to avoid misdiagnosis as a primary breast cancer or metastasis from another primary site.
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Sahoo B, Barik S, Naik S, Das Majumdar SK, Parida DK. Osteosarcoma of the Right Lower Femur With Breast and Axillary Lymph Node Metastasis: A Rare Case Presentation. Cureus 2021; 13:e20813. [PMID: 35141071 PMCID: PMC8799518 DOI: 10.7759/cureus.20813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 11/05/2022] Open
Abstract
Osteosarcoma is the most common skeletal malignancy and commonly metastasis to lung and bone. Here we report a case of osteosarcoma of the right knee with metastasis to the lower and inner quadrant of the breast along with axillary, mediastinal, retroperitoneal and inguinal lymphadenopathy with lung and liver metastasis. The diagnosis of breast metastasis was confirmed by ultrasonography-guided biopsy and immunohistochemistry (IHC). So this report highlights the rarest metastasis to breast and axillary lymph node from an osteosarcoma of the right knee primary.
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Qi Y, Kong X, Wang X, Zhai J, Fang Y, Wang J. Metastasis to Breast from Extramammary Solid Tumors and Lymphomas: A 20-Year Population-Based Study. Cancer Invest 2021; 40:325-336. [PMID: 34937471 DOI: 10.1080/07357907.2021.2019264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To discuss the clinicopathological features and prognosis of metastases to the breast from extramammary solid tumors and lymphomas, we reviewed Cancer Hospital of Chinese Academy of Medical Sciences database from 01/01/2000 to 12/31/2020. Fifty-nine patients were identified. The most common primary sites for breast metastases were lymph node and pulmonary, followed by nasal cavity, ovary, skin, etc. All the patients were treated with chemotherapy, 18 were operated, 14 accepted radiotherapy. Metastasis to breast should be considered in any patient with tumor history presenting a breast lump. Pathological with immunohistochemical examination should be performed to identify the original site.
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Affiliation(s)
- Yihang Qi
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Zhai
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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20
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Saywon DM, Mulamira P. Cervical squamous cell carcinoma metastasis to the breast - A case report from Uganda Cancer Institute. Gynecol Oncol Rep 2021; 38:100892. [PMID: 34926772 PMCID: PMC8651791 DOI: 10.1016/j.gore.2021.100892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Cervical squamous cell carcinoma does metastasize to the breast. Vagina exam is essential in a patient who presents with a breast mass. Immunohistochemistry is key in differentiating a primary lesion from a metastasis.
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Affiliation(s)
- Deazee M Saywon
- Department of Gynecological Oncology, Uganda Cancer Institute, Kampala, Uganda
| | - Pius Mulamira
- Gynecological Oncologist, Uganda Cancer Institute, Kampala, Uganda
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21
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Huayanay Espinoza JL, Mego Ramírez FN, Guerra Miller H, Guelfguat M. An Overview of Rare Breast Neoplasms with Radiologic-Pathologic Correlation. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Kowsarnia S, Javadi N. Ovarian Cancer With Breast Metastasis and Two Pathogenic Variants of BRCA1 Gene. Cureus 2021; 13:e18691. [PMID: 34790454 PMCID: PMC8583985 DOI: 10.7759/cureus.18691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open
Abstract
Ovarian cancer is the second most common gynecologic cancer after uterine cancer in the United States. Ovarian cancer ranks sixth in cancer deaths among women, accounting for more deaths than other female reproductive system cancers. Breast metastasis in ovarian cancer is a rare presentation and predicts a poor prognosis and challenging management. Our case is a 42-year-old Chinese woman with high-grade serous ovarian carcinoma that presents with metastasis to the breast during the course of her illness. Genetic evaluation of the ovarian tumor showed two BRCA1 pathogenic variants. Germline pathogenic variant of c.2110_2111DelAA and a somatic variant of c.4071_4096+14del40. Our patient was offered different treatment regimens but showed progression of her disease. The low survival rate and high recurrence rate in ovarian cancer show that we still need to investigate our current approved treatments. Our report aims to shed light on the genetic evaluation of ovarian tumors and treatment options available in refractory cases of progressive ovarian cancer. Furthermore, we explain our investigational therapy regimen and the reasoning behind it.
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Affiliation(s)
- Saeedeh Kowsarnia
- Research, Olive View-University of California, Los Angeles (UCLA) Education & Research Institute, Sylmar, USA
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23
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Bilateral breast metastases as the first manifestation of an occult pancreatic neuroendocrine tumor. Radiol Case Rep 2021; 16:3807-3814. [PMID: 34745398 PMCID: PMC8551534 DOI: 10.1016/j.radcr.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 11/23/2022] Open
Abstract
Breast metastases are uncommon findings compared to primary breast cancer and in particular bilateral secondary breast lesions from neuroendocrine tumor (NET)s are extremely rare with just less over 13 cases described in literature. We reported herewith the case of a 54-year-old woman who presented to our Breast Unit after noticing multiple, mobile, bilateral breast lumps. Imaging studies confirmed the presence of multiple, circumscribed, bilateral breast masses with slightly spiculated margins, classified as suspicious for malignancy (BI-RADS 4). A tru-cut biopsy was carried out on the largest lesion of each side and histopathologic and immunohistochemistry examination was consistent with metastases from pancreatic neuroendocrine tumor (PNET). Total-body CT revealed the presence of a mass located in the pancreatic body - tail with associated abdominal lymphadenopathies and multiple secondary nodules in bilateral breast and in the liver. Stage IV disease was diagnosed, patient did not undergo surgery and started LAR – octreotide therapy. Although rare, breast metastases from NETs represent an important diagnostic challenge for practitioners because of the difficulty to differentiate from a primary breast carcinoma or even from benign breast lesions. Clinicians should be aware of the possibility of bilateral breast metastases in differential diagnosis of breast lesions in order to ensure the correct diagnosis and the most appropriate management of these patients.
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24
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Valenza C, Porta FM, Rappa A, Guerini-Rocco E, Viale G, Barberis M, de Marinis F, Curigliano G, Catania C. Complex Differential Diagnosis between Primary Breast Cancer and Breast Metastasis from EGFR-Mutated Lung Adenocarcinoma: Case Report and Literature Review. ACTA ACUST UNITED AC 2021; 28:3384-3392. [PMID: 34590588 PMCID: PMC8482094 DOI: 10.3390/curroncol28050292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Abstract
We present a case of a woman with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma who received gefitinib for 2 years and obtained a partial response. The patient then developed liver metastasis and a breast lesion, displaying high estrogen receptor (ER) expression and harboring the same EGFR mutation. From the radiological studies, it was not possible to make a differential diagnosis between primary breast cancer and breast metastasis from lung cancer. After the removal of the breast nodule, thanks to the clinical history, radiology, and above all, molecular and immunohistochemical investigations, a diagnosis of breast metastasis from lung adenocarcinoma was made. This case emphasizes the importance of a comprehensive clinical, pathological, and molecular analysis in the differential diagnosis between primary breast cancer and metastases from extramammary tumor to guide adequate treatment decision making.
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Affiliation(s)
- Carmine Valenza
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (C.V.); (G.C.)
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (E.G.-R.); (G.V.)
| | - Francesca Maria Porta
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.P.); (A.R.); (M.B.)
- School of Pathology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Alessandra Rappa
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.P.); (A.R.); (M.B.)
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (E.G.-R.); (G.V.)
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.P.); (A.R.); (M.B.)
| | - Giuseppe Viale
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (E.G.-R.); (G.V.)
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.P.); (A.R.); (M.B.)
| | - Massimo Barberis
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (F.M.P.); (A.R.); (M.B.)
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (C.V.); (G.C.)
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy; (E.G.-R.); (G.V.)
| | - Chiara Catania
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
- Correspondence: ; Tel.: +39-02-57489773
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Omi Y, Kamio H, Yoshida Y, Masui K, Yamamoto T, Nagashima Y, Okamoto T. Breast metastasis from medullary thyroid carcinoma: a report of a case. Surg Case Rep 2021; 7:188. [PMID: 34410532 PMCID: PMC8377145 DOI: 10.1186/s40792-021-01273-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background Metastasis to the breast is rare. We herein report a patient with metastatic medullary thyroid carcinoma to the breast for whom measuring the calcitonin level was an important clue to the correct diagnosis. Case presentation A 54-year-old woman visited our hospital for the treatment of recurrent metastatic medullary thyroid carcinoma due to multiple endocrine neoplasia 2A and breast cancer. Positron emission tomography performed before the operation for metastatic medullary thyroid carcinoma recurrence in the neck showed the accumulation of 18F-fluorodeoxyglucose in the bilateral breast at sites other than the disease in the neck. Ultrasonography revealed multiple tumors in both breasts. A core needle biopsy of three breast tumors was performed. Microscopically, the tumor cells showed solid growth and did not show a tubular structure. She was diagnosed with triple-negative invasive ductal carcinoma. Post-operative positron emission tomography was performed as the serum calcitonin level increased after the operation. The accumulation of 18F-fluorodeoxyglucose in the bilateral breast tumors and lymph nodes in the neck was noted. The possibility of the breast tumors being metastasis of metastatic medullary thyroid carcinoma was considered. Needle aspiration was performed for three breast tumors. The calcitonin level of the washout fluid was measured and found to be ≥ 17,500 pg/mL. Immunohistochemistry showed that the tumor cells were calcitonin-positive and gross cystic disease fluid protein-15-negative. Vandetanib was started as recurrent metastatic medullary thyroid carcinoma with breast metastasis was finally diagnosed. The serum calcitonin level decreased after 1 month. Conclusion Although breast metastasis of medullary thyroid carcinoma is rare, a correct diagnosis is indispensable for appropriate treatment. When a breast tumor shows atypical morphological features for breast cancer according to the histopathology in a patient with a history of cancer, metastasis to the breast should be considered. Calcitonin measurement of the needle washout fluid was useful for confirming metastatic medullary thyroid carcinoma.
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Affiliation(s)
- Yoko Omi
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
| | - Hidenori Kamio
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kenta Masui
- Department of Diagnostic Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Tomoko Yamamoto
- Department of Diagnostic Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yoji Nagashima
- Department of Diagnostic Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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Osako T. How can we better distinguish metastatic tumors from primary tumors in the breast? Expert Rev Anticancer Ther 2021; 21:913-916. [PMID: 34132161 DOI: 10.1080/14737140.2021.1944107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tomo Osako
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Lee MI, Jung YJ, Kim DI, Paik HJ, Lee S, Jung CS, Kim JY, Kim HY. Metastasis to breast from ovarian cancer and primary ovarian cancer concurrently diagnosis. Gland Surg 2021; 10:1806-1811. [PMID: 34164325 DOI: 10.21037/gs-20-640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Metastasis to breast from ovarian cancer is very rare, and it is very difficult to distinguish the primary breast cancer from the secondary one. In our case, a 61-year-old woman presented to the hospital with complaints of lower abdominal pain and distention. Abdominal-pelvic computed tomography (CT) imaging revealed a solid ovarian cystic tumor with numerable ascites in the abdominal cavity and disseminated peritoneal carcinomatosis. To confirm the presence of metastasis in other organs, a preoperative imaging studies including chest CT was performed. Chest CT imaging revealed an enlargement of both the axillary lymph nodes (r/o metastatic lymphadenopathy) and breast imaging studies (breast sonography and mammography) revealed masses penetrated the pectoralis major muscle in the left breast and metastatic lymphadenopathy in Lt axilla. The core needle biopsy result of breast lesion showed unknown origin carcinoma with micropapillary features and no psammoma bodies. So, we could not distinguish primary breast cancer and breast metastasis from ovarian cancer because breast metastasis from ovary could be contained psammoma bodies, generally. Although the possibility of primary breast cancer could not be ruled out absolutely, the neoadjuvant chemotherapy included Paclitaxel and Carboplatin is known to be effective for both breast and ovarian cancer. So after neoadjuvant chemotherapy, mastectomy concurrently with ovarian cancer surgery was performed. The histopathologic features of the ovaries and breast were similar and psammoma bodies also could be observed, which were not detected in previous core needle biopsied specimen. And lymph nodes from the breast and the ovaries also showed consistent findings. Combined with histopathologic report and medical records, the final diagnosis confirmed as a metastasis of ovarian cancer to breast. After surgery, the patient has continued with metastatic ovarian cancer specific treatment. Breast metastatic tumors must be distinguished from primary breast tumors to avoid any unnecessary surgery. It might be difficult to diagnosis precisely by using only core needle biopsy because of inadequate specimen volume. Although surgical resection may be effective for both diagnosis and palliative treatment, further studies focused on less invasive biopsy are needed for exact histopathological diagnosis.
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Affiliation(s)
- Moon Il Lee
- Breast Surgery, Hwamyoung Ilsin Christian Hospital, Pusan, Korea
| | - Youn Joo Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-June Paik
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seungju Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Shin Jung
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jee Yeon Kim
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Yul Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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28
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Güldoğan N, İçten GE, Tokat F, Tutar B, Kara H, Korkmaz T, Oyan Uluç B, Demir G. Three Cases of Breast Metastases from Lung Cancer and Systematic Review of the Literature. Eur J Breast Health 2021; 17:200-205. [PMID: 33870122 DOI: 10.4274/ejbh.galenos.2020.5703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/01/2020] [Indexed: 12/01/2022]
Abstract
Despite the high prevalence of lung cancer among other primary tumors, metastasis of this particular malignancy in the breast is very rare. We report three new cases of lung cancer with breast metastases and discuss radiological and clinical findings. Radiologically, each case displayed different characteristics. First, one of them had bilateral superficially and deeply located irregular lesions. Second, the patient presented with findings similar to inflammatory breast cancer. The third case had a circumscribed mass, resembling a benign complicated cyst. To guide clinicians for proper patient management, radiologists should be aware of the scope of typical and atypical imaging findings of metastatic involvement of the breast.
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Affiliation(s)
- Nilgün Güldoğan
- Clinic of Breast, Acıbadem Altunizade Hospital, İstanbul, Turkey
| | - Gül Esen İçten
- Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Fatma Tokat
- Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Burçin Tutar
- Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Halil Kara
- Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Taner Korkmaz
- Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Başak Oyan Uluç
- Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Gökhan Demir
- Institude of Senology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
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29
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Arnaout K, Hawa N, Agha S, Kadoura L, Aloulou M, Ayoub K. A case report of multiple bilateral breast metastases after colorectal cancer. Int J Surg Case Rep 2021; 81:105759. [PMID: 33743246 PMCID: PMC8010451 DOI: 10.1016/j.ijscr.2021.105759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 01/09/2023] Open
Abstract
CRC metastasizes commonly to the regional lymph nodes, liver, lung, and rarely to breast. The radiologic investigations can play a role in the differentiation between the diagnosis of primary breast cancer and metastases. Immunohistochemically, the majority of breast adenocarcinomas are: negative for CDX2 and CK20 and positive for CK7, while colorectal adenocarcinomas are: positive for CDX2 and CK20, and negative for ER, PR, HER2, and CK7. The management plan of CRC metastases to the breast is complex and requires a multidisciplinary team.
Introduction and importance Although primary breast cancer is the most common tumor in women, breast metastases are rare findings. We report the first case in English literature with CRC metastases to the breast and adrenal gland concurrently. Case presentation A 42-year-old Caucasian female complained of abdominal pain over the last 3 days. Her history was remarkable for stage 2 colon cancer and she was free of disease for 2 years before the presentation, due to receiving Surgical-chemotherapy. The radiologic investigation showed a well-defined cystic mass in the left adrenal gland and left breast nodule. After adrenalectomy, the diagnosis of the mass was metastatic mucinous adenocarcinoma. During the surgical preparation, bilateral breast lumps were noticed. Histopathology of breast mass showed mucinous adenocarcinoma. Immunohistochemical staining revealed that the neoplastic gland was positive for CDX2, CK20, and P53 mutation and negative for CK7, PR, ER, and HER2. Overall, the diagnosis was metastatic colorectal adenocarcinoma to the breast. Clinical discussion Metastatic lesions in the adrenal gland tend to be bilateral with irregular shape. Breast metastases are singular unilateral lesions with predominance in the left breast. Biopsy and immunohistochemistry make the final diagnosis. The management plan is complex and depends on many factors like the general condition of the patient and the presence of other metastases. However, breast metastases may be a clinical clue to disseminated disease. Conclusion Breast metastases should be in the differential diagnosis in patients with a history of colorectal adenocarcinoma, in order to provide the appropriate clinical care.
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Affiliation(s)
- Khaled Arnaout
- Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Nouran Hawa
- Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Sarab Agha
- Department of Pathology, Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Lama Kadoura
- Department of Surgery, University of Aleppo, Aleppo, Syria.
| | - Marwa Aloulou
- Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Kusay Ayoub
- Instructor at General Surgery Department, Aleppo University Hospital, Aleppo University, Faculty of Medicine, Aleppo, Syria.
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30
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Buerba-Vieregge HH, Fernández-Ferreira R, Soberanis-Piña PD, De la Peña-López IR, Navarro-García LM, Macari-Jorge A. Breast Metastasis of Gastric Signet Ring Cell Carcinoma: A Case Report and Literature Review. Case Rep Oncol 2021; 14:165-172. [PMID: 33776699 PMCID: PMC7983628 DOI: 10.1159/000510938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022] Open
Abstract
Breast metastasis from gastric signet ring cell carcinoma is extremely rare in clinical practice. The estimated incidence is 0.5-1.3%. There are few cases reported in the literature (approx. less than 60) of breast metastasis from gastric signet ring cell carcinoma, and due to the rare association between gastric cancer and its extension to the breast, it is difficult to establish the diagnosis. Clinical history, histological findings, and immunohistochemical markers are helpful in distinguishing primary breast cancer from breast metastasis of gastric cancer. The treatment for breast metastasis from gastric carcinoma remains controversial. The prognosis of breast metastasis from gastric carcinoma is generally poor. We report a case of breast metastasis of gastric signet ring cell carcinoma in a 38-year-old woman. She started chemotherapy with ramucirumab, paclitaxel, and irinotecan. Three months later, a combined 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography showed a complete response. This is the first reported case of breast metastasis from gastric signet ring cell carcinoma with a complete response.
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Affiliation(s)
- Héctor Hugo Buerba-Vieregge
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Ricardo Fernández-Ferreira
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Pamela Denisse Soberanis-Piña
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Ildefonso Roberto De la Peña-López
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Lilian Mónica Navarro-García
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic and Foundation, Mexico, Mexico
| | - Andrés Macari-Jorge
- Service of Anatomical Pathology, Medica Sur Clinic and Foundation, Mexico, Mexico
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Maeshima Y, Osako T, Morizono H, Yunokawa M, Miyagi Y, Kikuchi M, Ueno T, Ohno S, Akiyama F. Metastatic ovarian cancer spreading into mammary ducts mimicking an in situ component of primary breast cancer: a case report. J Med Case Rep 2021; 15:78. [PMID: 33593410 PMCID: PMC7887787 DOI: 10.1186/s13256-020-02653-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background Accurate diagnosis of metastatic tumors in the breast is crucial because the therapeutic approach is essentially different from primary tumors. A key morphological feature of metastatic tumors is their lack of an in situ carcinoma component. Here, we present a unique case of metastatic ovarian carcinoma spreading into mammary ducts and mimicked an in situ component of primary carcinoma. To our knowledge, this is the second case (and the first adult case) confirming the in situ-mimicking growth pattern of a metastatic tumor using immunohistochemistry. Case presentation A 69-year-old Japanese woman was found to have a breast mass with microcalcifications. She had a known history of ovarian mixed serous and endocervical-type mucinous (seromucinous) carcinoma. Needle biopsy specimen of the breast tumor revealed adenocarcinoma displaying an in situ-looking tubular architecture in addition to invasive micropapillary and papillary architectures with psammoma bodies. From these morphological features, metastatic serous carcinoma and invasive micropapillary carcinoma of breast origin were both suspected. In immunohistochemistry, the cancer cells were immunoreactive for WT1, PAX8, and CA125, and negative for GATA3, mammaglobin, and gross cystic disease fluid protein-15. Therefore, the breast tumor was diagnosed to be metastatic ovarian serous carcinoma. The in situ-looking architecture showed the same immunophenotype, but was surrounded by myoepithelium confirmed by immunohistochemistry (e.g. p63, cytokeratin 14, CD10). Thus, the histogenesis of the in situ-like tubular foci was could be explained by the spread of metastatic ovarian cancer cells into existing mammary ducts. Conclusion Metastatic tumors may spread into mammary duct units and mimic an in situ carcinoma component of primary breast cancer. This in situ-mimicking growth pattern can be a potential pitfall in establishing a correct diagnosis of metastasis to the breast. A panel of breast-related and extramammary organ/tumor-specific immunohistochemical markers may be helpful in distinguishing metastatic tumors from primary tumors.
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Affiliation(s)
- Yurina Maeshima
- Division of Pathology, Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.,Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomo Osako
- Division of Pathology, Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan. .,Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Hidetomo Morizono
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mayu Yunokawa
- Department of Gynecologic Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yumi Miyagi
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mari Kikuchi
- Diagnostic Imaging Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takayuki Ueno
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Ohno
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Futoshi Akiyama
- Division of Pathology, Cancer Institute of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Khurram R, Amir T, Chaudhary K, Joshi A, Nayagam K, Tincey S. Metastatic renal cell carcinoma initially presenting as a unilateral breast lump. Radiol Case Rep 2021; 16:945-949. [PMID: 33659034 PMCID: PMC7896124 DOI: 10.1016/j.radcr.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 01/03/2023] Open
Abstract
Breast metastasis from primary renal cell carcinoma is a rare entity and infrequently reported in the literature. We present a case of a 65-year-old lady who presented to breast clinic with a 4-month history of rapidly growing right sided breast lump. She previously had a left mastectomy for breast cancer and a hysterectomy for endometrial cancer. Radiological evaluation with mammography and ultrasound revealed a large heterogeneous right breast lump with prominent vascularity which was biopsied. Histopathological and immunohistochemical features were not supportive of a primary breast carcinoma and favored metastasis from a renal tumor. The patient was unfortunately admitted to hospital due to increasing confusion and neurological symptoms and underwent whole-body cross-sectional CT imaging which demonstrated a giant tumor originating from the right kidney with associated intrathoracic, breast and intracranial metastasis. She was diagnosed with eosinophilic variant metastatic renal cell carcinoma. This case highlights the importance of considering alternative diagnoses to primary breast carcinoma in the context of an initial presentation of a unilateral breast lump.
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Affiliation(s)
- Ruhaid Khurram
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG,Corresponding author.
| | - Taha Amir
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Khurram Chaudhary
- Department of Cellular Pathology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Anupam Joshi
- Department of Cellular Pathology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Kesavan Nayagam
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
| | - Sophia Tincey
- Department of Radiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead, London, NW3 2QG
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Has Simsek D, Isik EG, Engin MN, Kuyumcu S, Mudun A, Sanli Y. Somatostatin receptor-positive breast lesions on 68Ga-DOTATATE PET/CT. Ann Nucl Med 2021; 35:270-277. [PMID: 33400149 DOI: 10.1007/s12149-020-01570-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sets out to evaluate patients with increased uptake in breast lesions on 68Ga-DOTATATE PET/CT (DOTA PET) and determine the clinical significance of somatostatin receptor (SSTR) positive breast lesions. METHODS We retrospectively evaluated all patients with increased SSTR uptake in breast lesions on DOTA PET. Patients with physiological (e.g., lactation) or normal variant breast uptake (e.g., mild diffuse glandular uptake) were excluded. The maximum standard uptake value (SUVmax) was calculated using a manually drawn region of interest in the most intense uptake of breast lesions. All lesions were correlated with breast imaging, including mammography and ultrasonography. Histopathological correlation was performed if the lesion was suspicious for malignancy. Lesions were followed up radiologically (1-8 years). RESULTS Out of 1573 retrospectively analyzed DOTA PET scans, the incidence of SSTR + breast lesions was measured as 1.1% (n = 18); however, 4 of 18 patients were excluded due to the lack of final diagnosis of lesions. The median age was 35 (range 14-58 years), and all patients were female. The median SUVmax of SSTR + breast lesions was 5.2 (range 1.5-12.6) for a total of 14 patients. Twelve patients had a single SSTR + breast lesion, while 2 patients had multiple SSTR + lesions on bilateral breasts. In 6 patients, single SSTR + lesions were considered as fibroadenoma; in 2 patients, multiple SSTR + lesions were considered as metastases of NET, based on correlative breast imaging. In 6 patients, histopathological confirmation was needed for the final diagnosis. Histopathologic findings confirmed fibroadenoma in 4 patients by biopsy, in 1 patient with surgical removal of the lesion. The last patient who had a history of IDC was diagnosed with a recurrence of IDC with biopsy. The median SUVmax was 5.1 (range 1.5-9.4) for malignant breast lesions and 5.4 (range 2.2-12.6) for benign breast lesions. CONCLUSION SSTR + breast lesions on DOTA PET are rarely seen in clinical practice. Uptakes of breast lesions in our cases were variable and not useful for differential diagnosis of lesions. It seems that SSTR + breast lesions should be evaluated with clinical and radiological characteristics, and correlative breast imaging and/or histopathological verification should be performed for suspicious lesions to avoid misdiagnosis.
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Affiliation(s)
- Duygu Has Simsek
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, İstanbul, Turkey.
| | - Emine Goknur Isik
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Muge Nur Engin
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Serkan Kuyumcu
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Ayse Mudun
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, İstanbul, Turkey
| | - Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, İstanbul, Turkey
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Picasso R, Pistoia F, Zaottini F, Sanguinetti S, Calabrese M, Martinoli C, Derchi L. Breast Metastases: Updates on Epidemiology and Radiologic Findings. Cureus 2020; 12:e12258. [PMID: 33520480 PMCID: PMC7834593 DOI: 10.7759/cureus.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The aim of this study was to report the prevalence of secondary breast malignancies and analyze their radiological characteristics. Materials and methods We collected 42,505 pathological reports of mammary biopsies performed from January 2000 to January 2019 in our hospital database, from which we screened reports of secondary cancer of the breast. We collected and analyzed imaging data from computed tomography (CT), ultrasound (US), and mammography. Mammograms, CT scans, and US images were reviewed by two breast radiologists. Prevalence of secondary breast malignancy among suspicious breast masses and all breast malignancies were calculated. Results Out of 42,505 histopathology reports from mammary biopsies, we found 19,354 malignancies. We identified 33 cases of secondary breast cancers (0.08% of suspicious breast lesions, 0.17% of breast malignancies). Most common metastases were from lymphoma (23 cases, 0.05% of suspicious breast lesions, 0.12% of breast malignancies) and melanoma (six cases, 0.01% of suspicious breast lesions, 0.03% of breast malignancies). All secondary lesions were hypoechoic on US and showed high density on mammogram. On CT, 83% of the lesions appeared solid/dense, and 17% were mixed, alternating areas of iso/hyperdensity with areas of hypodensity. Conclusion Secondary breast cancer had a prevalence of 0.17% among all breast malignancies. No specific imaging features, characteristic of secondary breast cancer, were found.
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Affiliation(s)
- Riccardo Picasso
- Radiology, Department of Health Sciences, University of Genova, Genoa, ITA
| | - Federico Pistoia
- Radiology, Department of Health Sciences, University of Genova, Genoa, ITA
| | - Federico Zaottini
- Radiology, Department of Health Sciences, University of Genova, Genoa, ITA
| | - Sara Sanguinetti
- Radiology, Department of Health Sciences, University of Genova, Genoa, ITA
| | | | - Carlo Martinoli
- Radiology, Department of Health Sciences, University of Genova, Genoa, ITA
| | - Lorenzo Derchi
- Radiology, Department of Health Sciences, University of Genova, Genoa, ITA
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35
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Cheng X, Zhao T, Jiang JN, Liu Y, Li H, Wang RY. Rare case of a male breast tumour secondary to poorly differentiated rectal adenocarcinoma. Transl Cancer Res 2020; 9:7676-7681. [PMID: 35117368 PMCID: PMC8799063 DOI: 10.21037/tcr-20-1936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 11/07/2022]
Abstract
Rectal cancer metastasis to the breast is rare. A case history is presented of a 57-year-old man with breast metastases from rectal carcinoma. However, this patient did not have metastasis in common metastatic sites, such as the liver, lung, and other organs. The patient had undergone chemotherapy for advanced rectal carcinoma 6 months earlier and presented with a mammary mass. An ultrasound-directed core needle biopsy of the breast mass was performed. Cytology indicated an adenocarcinoma with poor to moderate differentiation in the breast mass Immunohistochemistry (IHC) showed cytokeratin (CK) expression with a pattern that is characteristic of colorectal tumours: CK7(−), CK20(+), CDX2(−), Villin(+) TOPOII(−), and a Ki-67 index of 30%. The 3 main breast tumour markers were negative. Based on these histopathological and immunohistochemical findings, the patient was diagnosed with breast metastases from rectal carcinoma. Distant metastasis should be taken into account when a patient has a medical history of rectal adenocarcinoma, even when a rare metastasis site is involved. We should be vigilant when patients have some features that are favorable for metastasis. Histopathological characteristics and immunohistochemical tests are helpful for diagnosis. Regardless of surgical treatment after neoadjuvant chemotherapy, standard chemotherapy regimens for intestinal tumors, and EGFR molecular-targeted drugs, there is no obvious effect and the prognosis is poor. The treatment method needs further study.
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Affiliation(s)
- Xia Cheng
- Graduate School, Dalian Medical University, Dalian, China
| | - Tong Zhao
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jia-Ning Jiang
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ying Liu
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Heming Li
- The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Dalian, China
| | - Ruo-Yu Wang
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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36
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Economopoulou P, Chrysikopoulou A, Goula K, Papiri I, Psyrri A, Kotsantis I, Arkadopoulos N, Michalopoulos NV. Breast Metastasis from Neuroendocrine Carcinoma of the Lung: A Case Report and Review of the Literature. Case Rep Oncol 2020; 13:1281-1284. [PMID: 34191931 PMCID: PMC7649700 DOI: 10.1159/000510936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022] Open
Abstract
Breast metastasis originating from non-mammary tumors is an uncommon event accounting for 0.5-6.6% of all breast neoplasms. The primary malignancies that reportedly metastasize to the breast most frequently are hematologic malignancies, such as leukemia and lymphoma and malignant melanoma. Breast cancer metastasis resulting from a primary lung neoplasm is significantly less commonly described in the literature. Herein, we present the unusual case of a patient with metastatic disease to the breast from a primary lung tumor.
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Affiliation(s)
- Panagiota Economopoulou
- Section of Medical Oncology, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Athena Chrysikopoulou
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Kalliroi Goula
- Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ilectra Papiri
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Amanda Psyrri
- Section of Medical Oncology, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioannis Kotsantis
- Section of Medical Oncology, Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos V Michalopoulos
- Fourth Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Zagami P, Kandaraki E, Renne G, Grimaldi F, Spada F, Laffi A, Fazio N. The rare entity of bilateral and unilateral neuroendocrine metastases to the breast: a case series and literature review. Ecancermedicalscience 2020; 14:1123. [PMID: 33209114 PMCID: PMC7652541 DOI: 10.3332/ecancer.2020.1123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Primary neuroendocrine neoplasms (NENs) in the breast are very rare. Until 2011, the prevalence was 0.1% of all breast lesions and 1% of all NENs, whereas metastatic breast NENs represent 1%–2% of all breast tumours. However, it seems that over the last 5 years the diagnostic frequency of breast NENs has increased, probably for more alert specialists and advanced diagnostic tools, leading to a prevalence of 2%–5% of diagnosed breast cancers, mostly in the elderly population. Breast metastases from extramammary malignancies are uncommon and bilateral ones are even more uncommon, with few reported in the literature. We describe four clinical settings of breast metastases from different NENs and the multidisciplinary approach for diagnosis and treatment. Methods Four patients were found to have NEN primaries metastasised to the breast. A literature review was conducted to identify similar cases and characterise breast metastases from neuroendocrinal tumors (NETs). Results Two patients presented with bilateral breast metastases (one with well-differentiated panNET and another with atypical lung carcinoid) and two had unilateral (one with moderately differentiated lung NET and one with atypical lung carcinoid). There are about 13 cases of NEN breast metastases reported in the English literature. The ileum is the most common primary site, followed by the appendix, duodenum, pancreas and lung. Conclusion Breast lesions from extramammary primary often pose a diagnostic challenge, since a breast nodule can be the first and often the only presentation of the disease. However, differentiating between primary and secondary NEN breast lesions is essential, owing to different clinical management and prognosis.
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Affiliation(s)
- Paola Zagami
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
| | - Eleni Kandaraki
- Department of Pathology, European Institute of Oncology, Milan 20132, Italy
| | - Giuseppe Renne
- Department of Pathology, European Institute of Oncology, Milan 20132, Italy
| | - Franco Grimaldi
- Endocrinology and Metabolism Unit, University of Udine, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
| | - Alice Laffi
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumours, European Institute of Oncology, IEO, IRCCS, Milan 20132, Italy
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Laforga JB, Dominguez E, Aranda FI. Breast metastasis from medullary thyroid carcinoma mimicking ductal carcinoma with neuroendocrine differentiation. Cancer Rep (Hoboken) 2020; 3:e1292. [PMID: 33025739 PMCID: PMC7941419 DOI: 10.1002/cnr2.1292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Medullary thyroid carcinoma very rarely metastasizes to the breast. Hematogenous spread to the liver, lungs, or mediastinum is more common. CASE We describe the morphologic and immunohistochemical features of a 63-year-old woman who presented with a BIRADS-5 category nodule in the right breast and enlarged axillary lymph nodes. Core biopsy showed suggested breast cancer with neuroendocrine or apocrine differentiation. The immunohistochemical profile showed (RE-/RP-/HER-2-) and Ki67 10%. Chromogranin and synaptophysin were positive; AR and GCDFP-15 were negative. On reviewing the patient's clinical history, it was discovered that she had been treated for medullary thyroid carcinoma 15 years earlier. Additional stains showed positivity for TTF-1, CEA, and calcitonin. These findings were consistent with a diagnosis of breast metastasis from medullary thyroid carcinoma. We discuss briefly the morphologic features and the possible key features in order to make an accurate diagnosis. CONCLUSION This case highlights the importance of investigating a history of cancer in patients with discordant or unusual histologic or immunohistochemical findings, as this can help avoid misdiagnosis and inappropriate treatment.
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39
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Do T, Epistola R, Hua DT, Taylor MM, Venegas R. Diagnostic Delays in Metastatic Amelanotic Melanoma Presenting as Breast Pain. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921360. [PMID: 32756533 PMCID: PMC7431016 DOI: 10.12659/ajcr.921360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Female, 58-year-old Final Diagnosis: Metastatic amelanotic melanoma Symptoms: Breast mass • breast pain Medication: — Clinical Procedure: Mastectomy Specialty: Dermatology • Oncology
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Affiliation(s)
- Tiffanie Do
- Department of Internal Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Raisa Epistola
- Department of Internal Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Duong T Hua
- Department of Internal Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Maria M Taylor
- Department of Pathology, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Rose Venegas
- Department of Pathology, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, CA, USA
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40
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Choudhery S, Xiao L, Zingula S. Review of Nonmammary Metastases to the Breast: Imaging and Clinical Presentation. Curr Probl Diagn Radiol 2020; 50:495-498. [PMID: 32534793 DOI: 10.1067/j.cpradiol.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of our study is to review the imaging findings of breast metastases from nonmammary sources at our institution and to explore the mode of initial detection of these breast metastases. METHODS In this study, we reviewed our electronic medical record and our breast imaging database for all patients who presented with nonmammary metastases to breasts between 5/1/2009 and 12/1/2019. We reviewed all available imaging data, clinical notes, and pathology reports. RESULTS Sixteen cases of nonmammary metastases to the breast were included in this study, of which there were 4 (25%) metastases from melanoma, 3 (19%) from carcinoid tumor, 2 (13%) from lung cancer, 2 (13%) from leiomyosarcoma, 1 (6%) each from lipsarcoma, renal cell carcinoma, colon cancer, neuroendocrine tumor, and adenoid cystic carcinoma. 6/8 (75%) lesions that had breast imaging were oval in shape with circumscribed or microlobulated margins on mammography and/or ultrasound. 13/16 (81%) breast metastases were asymptomatic and diagnosed on systemic staging exams. Three out of 16 (19%) nonmammary breast metastases were palpable and were diagnosed on subsequent breast imaging. CONCLUSIONS Most (25%) nonmammary breast metastases in our patient population occur from melanoma and most breast metastases (75%) are oval in shape with circumscribed or microlobulated margins. Majority (81%) of these lesions are asymptomatic and initially diagnosed on systemic staging tests, and the remaining are discovered as palpable lesions.
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Affiliation(s)
| | - Lekui Xiao
- Department of Radiology, Mayo Clinic, Rochester, MN
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Guerrouaz MA, Samba S, BenSghier A, Sbai A, Mezouar L. Breast Metastasis From a Non-small Cell Lung Cancer: A Case Report. Cureus 2020; 12:e7460. [PMID: 32351839 PMCID: PMC7188011 DOI: 10.7759/cureus.7460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although primary breast cancer (BC) is the most frequent cancer in the world, their mammary metastases are rare. In this paper, we report the case of a 51-year-old male patient diagnosed with a mammary lump and an intracranial hypertension syndrome. Mammography showed the presence of an irregular opacity without microcalcifications. After a cytological and immunohistochemical examination, the breast biopsy showed an adenocarcinoma of pulmonary origin. Computed tomography (CT) scans of the cerebrum, cervicothoracic spine, and abdomen showed a right apical pulmonary tumor associated with Barety's lymphadenopathy, as well as the presence of a mass in the right breast and secondary brain lesions. The patient received total brain irradiation which resulted in a marked clinical improvement. Afterward, he was treated with six cycles of palliative chemotherapy based on carboplatin area under the curve (AUC) 6 and paclitaxel, 175 mg/m² every 21 days, with a good response. After two months, the patient presented with a progression and he was treated with second-line chemotherapy. However, after three chemotherapy courses, the disease rapidly progressed and the patient was altered which required his admission to the palliative care department. The patient died 40 days later. This case shows the poor prognostic survival outcomes in this population of patients.
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Affiliation(s)
| | - Soumiya Samba
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed Vi, Oujda, MAR
| | - Ahmed BenSghier
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed Vi, Oujda, MAR
| | - Ali Sbai
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed Vi, Oujda, MAR
| | - Loubna Mezouar
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed Vi, Oujda, MAR
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Salibay C, Fadare O. High-Grade Endometrioid Carcinoma of the Endometrium With a GATA-3-Positive/PAX8-Negative Immunophenotype Metastatic to the Breast: A Potential Diagnostic Pitfall. Int J Surg Pathol 2020; 28:631-636. [PMID: 32188328 DOI: 10.1177/1066896920913114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report describes clinicopathologic findings from the case of a patient with a breast mass that was ultimately diagnosed as a metastatic high-grade endometrioid carcinoma of endometrial origin. The breast lesion as well as the solid areas of the endometrial lesion displayed a similar immunoprofile: GATA3-positive; synaptophysin positive; negative for mammaglobin, gross cystic disease fluid protein-15, chromogranin, estrogen receptor, progesterone receptor, and HER2/neu; and intact expression of the DNA mismatch repair proteins MLH1, MSH2, MSH6, and PMS2. The breast lesion was negative for PAX-8, whereas the solid areas of the endometrial lesion showed focal weak positivity. A review of the literature on GATA-3 expression in endometrial carcinomas found a reported frequency of expression that ranged from 0% to 13% of cases, typically in a patchy, focal, and generally restricted pattern. However, GATA-3 may be diffusely expressed in high-grade endometrial carcinomas. Since the potential for PAX-8 expression to be lost in high-grade endometrioid carcinomas is well known, a GATA-3-positive/PAX8-negative immunoprofile may be encountered in high-grade endometrioid carcinomas of the endometrium, and this composite immunoprofile is a potential diagnostic pitfall when such a lesion is being evaluated in a breast metastasis.
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Ganguly S, Alphones S, Ghosh P, Midha D, Ghosh J, Biswas B. Rectal cancer with breast metastasis: A case report with review of literature. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_102_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Nidhamalddin SJ, Hassan HA, Ali K, Ghareeb KAH, Gubari MIM. Breast cancer metastasis from Gastric Carcinoma in a young female. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/115858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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45
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Patkar S, Acharya MR, Kansaria R, Seth T, Shah A, Goel M. Cholangiocarcinoma Metastasizing to the Breast: An Unknown Entity. J Gastrointest Cancer 2019; 51:654-657. [PMID: 31808056 DOI: 10.1007/s12029-019-00348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shraddha Patkar
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - M Rajgopal Acharya
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ruchit Kansaria
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Tanuja Seth
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Aekta Shah
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mahesh Goel
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Wu X, Wang H, Fang M, Li C, Zeng Y, Wang K. ALK or ROS1-rearranged breast metastasis from lung adenocarcinoma: a report of 2 cases. TUMORI JOURNAL 2019; 105:NP67-NP71. [PMID: 31910790 DOI: 10.1177/0300891619872548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Breast metastases from extramammary sites are extremely rare, with an incidence of 0.4%-1.3% reported in the literature. Insufficient knowledge about its pathology and genetic mutation often leads to misdiagnosis and delayed treatment. CASE PRESENTATION We present 2 patients with synchronous (case 1) or metachronous (case 2) breast nodules, revealed as atypical breast metastases from pulmonary adenocarcinomas, in which ALK or ROS1 rearrangement were finally detected in breast mass. After they failed sequential treatments with standard chemotherapies for lung and breast cancer, we reexamined breast lump biopsy and found they were all lung adenocarcinoma metastasis to the breast with the presence of an ALK rearrangement in one case and of ROS1 rearrangement in the other. Eventually these 2 patients were treated with crizotinib. Both the primary tumor and the metastasis of these 2 patients were significantly regressed. CONCLUSION Whenever a diagnosis of a suspected tumor with sites at more than one organ is made, pathologic as well molecular pathologic examinations designated for organ-specific cancers should be done.
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Affiliation(s)
- Xiao Wu
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Guangdong, China
- Cancer Research Center, Shantou University Medical College, Guangdong, China
| | - Hong Wang
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Mei Fang
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Chun Li
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Yun Zeng
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Kai Wang
- Department of Pathology, Cancer Hospital of Shantou University Medical College, Guangdong, China
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McEachron J, Mendoza R, Lee YC, Kanis MJ. Breast metastases: A rare manifestation of advanced uterine serous carcinoma. Gynecol Oncol Rep 2019; 30:100500. [PMID: 31656850 PMCID: PMC6806454 DOI: 10.1016/j.gore.2019.100500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 11/28/2022] Open
Abstract
Metastasis to the breast is a rare, accounting for <1.0% of all breast tumors. Over 50% of patient with USC will recur despite multimodality treatment. The majority of USC recur locally within the pelvis or abdominal cavity. Hematogenous metastasis to the breast has not been reported in USC. A new breast mass in a patient with USC is more likely to primary breast cancer.
Metastasis of non-mammary tumors to the breast are uncommon, representing <1% of all breast tumors. Breast metastasis are associated with advanced disease and poor prognosis regardless of the origin of the primary tumor. Uterine cancer metastasis to the breast is an extremely rare finding and has not been reported in the case of serous histology. Here, we review two cases of uterine serous carcinoma metastatic to the breast. Both patients presented with breast-specific complaints including pain and palpable mass and were found to have widely metastatic disease. Tissue biopsy and immunohistochemistry consistent with primary uterine serous carcinoma confirmed the diagnosis of metastasis in both cases. Our findings suggest hematogenous metastasis to the breast is a late phenomenon in the course of endometrial carcinoma and associated with the development of disease at multiple sites. This emphasizes the importance of complete evaluation in patients presenting with breast complaints and known history of malignancy, as this may be the only presenting symptoms in patients with widely metastatic disease.
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Affiliation(s)
- Jennifer McEachron
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States
| | - Rachel Mendoza
- Division of Pathology, SUNY Downstate Medical Center, United States
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, SUNY Downstate Medical Center, United States
| | - Margaux J Kanis
- Division of Gynecologic Oncology, New York-Presbyterian Brooklyn Methodist Hospital, United States
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Sudhir R, Chaudhary VK, Ahmed F, Raju KV. Breast metastasis as initial presentation of asymptomatic gastroesophageal carcinoma: A case report. Indian J Cancer 2019; 56:370-371. [PMID: 31607711 DOI: 10.4103/ijc.ijc_159_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rashmi Sudhir
- Department of Radiodiagnosis, Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, Telangana, India
| | - Veeriah K Chaudhary
- Department of Radiodiagnosis, Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, Telangana, India
| | - Faiq Ahmed
- Department of Pathology and Lab Medicine, Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, Telangana, India
| | - K Vvn Raju
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, Telangana, India
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49
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Quaquarini E, Vanoli A, Frascaroli M, Viglio A, Lucioni M, Presti D, Lobascio G, Pietrabissa A, Bernardo A, Paulli M. Bilateral Breast Metastases from Epstein-Barr Virus-Associated Gastric Cancer during Pregnancy: Is There a Method to Its Madness? J Gastric Cancer 2019; 20:106-114. [PMID: 32269849 PMCID: PMC7105417 DOI: 10.5230/jgc.2020.20.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/27/2019] [Accepted: 08/24/2019] [Indexed: 11/20/2022] Open
Abstract
Breast metastases of extramammary malignant neoplasms are rare, with an incidence of 0.3%-2.7% among all malignant mammary tumors. Breast metastases from gastric carcinoma are very rare (<0.1%), and this event is even rarer during pregnancy. Herein, we describe a 39-year-old Caucasian woman with a history of an Epstein-Barr virus-associated gastric carcinoma (EBVaGC) that was characterized by prominent tumor infiltrating lymphocytes. Three years after undergoing radical surgery, the patient developed bilateral breast nodules during her pregnancy. A breast biopsy was performed, and histology confirmed a diagnosis of EBVaGC; tumor cells showed positivity for cytokeratin 8/18 and E-cadherin, and negativity for cytokeratin 7, cytokeratin 20, cytokeratin 5/6, caudal type homebox 2, androgen receptor, mammaglobin, gross cystic disease fluid protein-15, and estrogen and progesterone receptors. We also discuss the main diagnostic pitfalls. To our knowledge, this is the first report of an EBVaGC with lymphoid stroma that developed breast metastases during pregnancy.
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Affiliation(s)
- Erica Quaquarini
- Medical Oncology Unit, IRCCS ICS Maugeri SpA SB, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, PhD in Experimental Medicine, Pavia, Italy
| | - Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mara Frascaroli
- Translational Oncology Unit, IRCCS ICS Maugeri SpA SB, Pavia, Italy
| | - Alessandra Viglio
- Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Lucioni
- Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Daniele Presti
- Medical Oncology Unit, IRCCS ICS Maugeri SpA SB, Pavia, Italy
| | - Gessica Lobascio
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Andrea Pietrabissa
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of General Surgery 2, University of Pavia and IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | | | - Marco Paulli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
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50
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Hasegawa H, Nagata Y, Sakakibara Y, Miyake M, Mori K, Masuda N, Mano M, Nakazuru S, Ishida H, Mita E. Breast metastasis from rectal cancer with BRAF V600E mutation: a case report with a review of the literature. Clin J Gastroenterol 2019; 13:153-157. [PMID: 31482523 DOI: 10.1007/s12328-019-01035-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022]
Abstract
Metastasis of rectal cancer to the breast is an extremely rare clinical event. We report the case of a 67-year-old woman with a metastatic breast tumor derived from a BRAF V600E mutant rectal carcinoma that was diagnosed and resected curatively 1 year previously. Computed tomography showed a left breast mass and multiple lung nodules suspected to be indicative of recurrent rectal cancer. The ultrasonography examination demonstrated a 10 × 10-mm hypoechoic solid lesion in the left breast with an elevation in the serum carcinoembryonic antigen level and serum carbohydrate antigen 19-9 level. Core needle biopsy was performed, and histopathologic examination showed Cytokeratin 20 and CDX-2 positivity, compatible with rectal cancer. To our knowledge, this is the first case of a metastatic breast tumor arising from rectal carcinoma with BRAF mutation. Although breast metastasis is very rare event, the possibility of breast metastasis from extra mammary sites should be considered when the breast tumor is found in cancer treatment.
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Affiliation(s)
- Hiroko Hasegawa
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
| | - Yoko Nagata
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Yuko Sakakibara
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Kiyoshi Mori
- Department of Pathology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Norikazu Masuda
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Masayuki Mano
- Department of Pathology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Shoichi Nakazuru
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Hisashi Ishida
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Eiji Mita
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
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