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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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Ramos Portales M, Bermúdez Barrientos CG, Rodríguez Valencia NA, Moreno Jaime B. Breast Metastasis From Cutaneous Melanoma: Beyond the Infiltrating Ductal Carcinoma. Cureus 2024; 16:e60931. [PMID: 38910784 PMCID: PMC11193477 DOI: 10.7759/cureus.60931] [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: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Breast metastases of extramammary origin are an extremely rare entity. Solid organ metastases to the breast include malignant melanoma, epithelial carcinoma (adenocarcinoma and squamous cell carcinoma of the lung and gastrointestinal tract), and sarcoma. A breast neoplasm can be caused by a primary tumor, in-transit metastasis, breast metastasis, and skin metastasis. A 42-year-old female patient presented with a hyperpigmented lesion on the first finger of her left hand. An incisional biopsy was carried out, reporting pigmented epithelioid melanoma. Amputation of the finger was performed, as well as an axillary sentinel lymph node excision. Later during the treatment and follow-up by medical oncology, a breast tumor was located, followed by a protocol and the approach of possible differential diagnoses. Finally, it was characterized as metastatic cutaneous melanoma. The therapeutic approach regarding the possible origin of the metastatic neoplastic character of breast tumors culminated in this case in the palliative treatment with immunotherapy of cutaneous malignant melanoma. The diagnosis of breast metastases from cutaneous malignant melanoma is a real challenge, so an extensive history and high clinical suspicion are crucial in order to provide adequate treatment, despite the gloomy prognosis.
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Affiliation(s)
- Marisol Ramos Portales
- General Surgery, Institute for Social Security and Services for State Workers Regional Hospital, Leon, MEX
| | | | - Nishdaly A Rodríguez Valencia
- Dermatology, Institute for Social Security and Services for State Workers Regional Hospital "Lic. Adolfo Lopez Mateos", Mexico City, MEX
| | - Brizio Moreno Jaime
- Medical Oncology, Institute for Social Security and Services for State Workers Regional Hospital, Leon, MEX
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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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Calderón-Montero Y, Quevedo-Ramírez N, Campos-Bernardo MDLC, Pérez-Castillo R. Carcinoma de Merkel primario de la mama en un hombre con injerto cutáneo: reporte de caso. REVISTA DE LA FACULTAD DE MEDICINA 2022. [DOI: 10.15446/revfacmed.v71n1.93988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El carcinoma de células de Merkel (CCM) es un cáncer neuroendocrino de la piel, agresivo, muy poco frecuente que, por lo general, aparece como un nódulo en la cara, cabeza o cuello. El CCM ocurre principalmente en adultos mayores.
Presentación del caso. Hombre de 85 años, blanco, que asistió al Servicio de Mastología del Instituto Nacional de Oncología y Radiobiología (INOR), en La Habana, Cuba, por aumento de volumen, cambio de color y temperatura en la mama derecha. El paciente había sufrido trauma térmico en el hemitórax derecho 18 años antes de la consulta, el cual fue tratado mediante injerto cutáneo del muslo. En los estudios de imagen (ultrasonido, mamografía, resonancia magnética y tomografía computarizada) se observó un nódulo con características imagenológicas sugestivas de malignidad. El diagnóstico de CCM se confirmó mediante biopsia por punción con aguja gruesa, donde se reportó positividad de marcadores CD-56, CK-7 y Ki- 67.
Conclusiones. Característicamente, el CCM se presenta como nódulos cutáneos firmes de rápido crecimiento en las áreas expuestas al sol, a diferencia del presente caso, en el que la lesión apareció en la piel injertada en el hemitórax derecho. Reconocer hallazgos imagenológicos sugestivos de esta neoplasia es de gran importancia para el diagnóstico en zonas inusuales del cuerpo como la mama.
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Allison KH. Ancillary Prognostic and Predictive Testing in Breast Cancer: Focus on Discordant, Unusual, and Borderline Results. Surg Pathol Clin 2018; 11:147-176. [PMID: 29413654 DOI: 10.1016/j.path.2017.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ancillary testing in breast cancer has become standard of care to determine what therapies may be most effective for individual patients with breast cancer. Single-marker tests are required on all newly diagnosed and newly metastatic breast cancers. Markers of proliferation are also used, and include both single-marker tests like Ki67 as well as panel-based gene expression tests, which have made more recent contributions to prognostic and predictive testing in breast cancers. This review focuses on pathologist interpretation of these ancillary test results, with a focus on expected versus unexpected results and troubleshooting borderline, unusual, or discordant results.
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Affiliation(s)
- Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Lane 235, Stanford, CA 94305, USA.
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