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Steven W, Szarmach JL, Raghu M, Bakhru S, Everett T, Flaherty F, Boroumand G. A rare case of primary breast lymphoma presenting as calcifications on screening mammography. Radiol Case Rep 2024; 19:1734-1739. [PMID: 38384692 PMCID: PMC10877128 DOI: 10.1016/j.radcr.2024.01.056] [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: 11/20/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Extranodal marginal zone lymphoma (EMZL) is a low-grade subtype of B-cell non-Hodgkin lymphoma that can affect any mucosal tissue, most commonly the GI tract. Primary involvement of the breast, known as primary breast lymphoma (PBL), is a very rare manifestation. We report an unusual case of a 65-year-old woman with primary breast EMZL presenting as calcifications discovered during screening mammography. This represents an exceedingly atypical appearance of primary breast lymphoma that is rarely described in the literature.
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Affiliation(s)
- Wojtkiewicz Steven
- Department of Radiology, Norwalk Hospital, 34 Maple St, Norwalk, CT 06850, USA
| | - Jaime L Szarmach
- Department of Radiology, Norwalk Hospital, 34 Maple St, Norwalk, CT 06850, USA
| | - Madhavi Raghu
- Department of Radiology, Norwalk Hospital, 34 Maple St, Norwalk, CT 06850, USA
| | - Seema Bakhru
- Department of Radiology, Norwalk Hospital, 34 Maple St, Norwalk, CT 06850, USA
| | - Todd Everett
- Department of Radiology, Norwalk Hospital, 34 Maple St, Norwalk, CT 06850, USA
| | - Francis Flaherty
- Department of Radiology, Norwalk Hospital, 34 Maple St, Norwalk, CT 06850, USA
| | - Gilda Boroumand
- Department of Radiology, Norwalk Hospital, 34 Maple St, Norwalk, CT 06850, USA
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2
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Chabot C, Coman CG, Borgmann FK, Crisan F, Janssens D, Azzouzi DE. Breast metastases from extra-mammary cancers: A report of 3 challenging cases and literature review. Radiol Case Rep 2024; 19:1100-1105. [PMID: 38229605 PMCID: PMC10789930 DOI: 10.1016/j.radcr.2023.12.020] [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: 09/05/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024] Open
Abstract
We report 3 cases of patients with a history of extra-mammary cancer who presented with breast nodules, leading to diagnostic challenges and occasional misleading imaging findings. These cases highlight the significance of radiologists considering breast metastases as a potential component of the differential diagnosis when assessing patients with a history of cancer who exhibit palpable breast nodules. Furthermore, these cases underscore the importance of integrating various imaging techniques with histological and immunohistochemical analyses of the lesions to achieve precise diagnoses, ultimately ensuring the highest quality of care for these patients.
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Affiliation(s)
- Caroline Chabot
- Department of Radiology and Plastic Surgery, Centre Hospitalier de Luxembourg, 4 Rue Nicolas-Ernest Barblé, 1210 Luxembourg
- Department of Radiology, Université Catholique de Louvain, Avenue Emmanuel Mounier 51, Bruxelles Woluwe, Belgium
| | - Corneliu-George Coman
- Department of Radiology and Plastic Surgery, Centre Hospitalier de Luxembourg, 4 Rue Nicolas-Ernest Barblé, 1210 Luxembourg
| | - Felix Kleine Borgmann
- Department of Cancer Research, Luxembourg Institute of Health, 6A Rue Nicolas-Ernest Barblé, 1210 Luxembourg
| | - Flaviu Crisan
- Department of Pathology, Laboratoire National de la Santé, 1 Rue Louis Rech, Dudelange, 3555, Luxembourg
| | - Daniel Janssens
- Department of Radiology and Plastic Surgery, Centre Hospitalier de Luxembourg, 4 Rue Nicolas-Ernest Barblé, 1210 Luxembourg
| | - Dounia El Azzouzi
- Department of Radiology and Plastic Surgery, Centre Hospitalier de Luxembourg, 4 Rue Nicolas-Ernest Barblé, 1210 Luxembourg
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3
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Grover H, Grover SB, Leah Forman F, Khanna G, Margolies L. Multiple bilateral breast masses due to lymphoma metastases: A report of 2 cases highlighting the mammographic and sonographic features. Radiol Case Rep 2024; 19:357-369. [PMID: 38033677 PMCID: PMC10682527 DOI: 10.1016/j.radcr.2023.10.026] [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: 09/20/2023] [Revised: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 12/02/2023] Open
Abstract
Metastases within breast usually occur due to a primary malignancy in the contralateral breast. Breast metastases from extra mammary malignancies are known to be very rare and the primary tumors are reported to be melanoma, lung cancer, gastro-intestinal primary tumors, neuroendocrine tumors, sarcomas, ovarian tumors and lymphomas. Breast lymphomas comprise 0.04%-0.7% of all cases of breast malignancies and may manifest either as a primary or a secondary variety. A primary breast lymphoma is known to be more infrequent than a secondary breast lymphoma. In patients with breast metastases the usual clinical presentation is with multiple palpable masses and imaging evaluation is the mainstay for initial diagnosis. We report the imaging features seen in 2 almost identical cases of secondary breast lymphoma. At mammography, multiple, round to elliptical, sharply circumscribed, high-density masses were seen, in which spiculation, calcification and architectural distortion were conspicuously absent. On sonography, these round /oval masses were homogenously hypoechoic, sharply circumscribed, showed a thin echogenic rim with posterior acoustic enhancement and were moderately to profusely vascular on color Doppler examination. These imaging features should suggest the possible diagnosis of metastases from a hematogenous malignancy and an ultrasound guided biopsy should be performed. Once the etiology of lymphoma is confirmed, a rigorous multi- modality imaging work up to identify the primary site, stage the disease and document other sites of dissemination is warranted.
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Affiliation(s)
- Hemal Grover
- Department of Radiology, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Shabnam Bhandari Grover
- Department of Radiology, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306, Uttar Pradesh, India
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi 110029, India
| | - Frimmit Leah Forman
- Department of Radiology, Icahn School of Medicine Mount Sinai, New York, NY, USA
| | - Geetika Khanna
- Department of Pathology, VMMC and Safdarjung Hospital, New Delhi 110029, India
| | - Laurie Margolies
- Department of Radiology, Icahn School of Medicine Mount Sinai, New York, NY, USA
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4
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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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5
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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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6
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Pipal VR, Singh P, Pipal DK, Elhence P. Skin Metastases in Ovarian Malignancy: A Case Report with Literature Review. J Midlife Health 2023; 14:49-52. [PMID: 37680376 PMCID: PMC10482014 DOI: 10.4103/jmh.jmh_137_22] [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: 07/24/2022] [Revised: 03/10/2023] [Accepted: 04/06/2023] [Indexed: 09/09/2023] Open
Abstract
Ovarian cancer is the most lethal gynecologic malignancy, mostly diagnosed in the advanced stage with multiple sites of metastases. Routes of spread are direct through exfoliation, lymphatic channels, and less commonly hematogenous spread. Skin metastasis in ovarian malignancy is a rare occurence, its incidence range from 1.9% to 5.1% and the most common sites are the abdominal wall and chest wall. The incidence of metastasis to breast and/or axillary lymph nodes is very rare, ranging from 0.03% to 0.6%. We report the case of a 60-year-old female with stage IV B undifferentiated ovarian carcinoma with multiple cutaneous metastases involving the skin over the left breast, scalp, and mediastinal lymph nodes, which are rare sites of metastases. The incidence of cutaneous metastasis in ovarian cancer is 1.9%-5.1% and the overall survival after diagnosis ranges from 2 to 65 months.
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Affiliation(s)
- Vibha Rani Pipal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Pratibha Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Dharmendra Kumar Pipal
- Department of General Surgery, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Poonam Elhence
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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7
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Santana Valenciano Á, Juez Sáez LD, Pérez Mies B, Moreno SC, Fidalgo SR, Montero JC. Breast metastases from non-primary breast malignancies: What should we know? Breast Dis 2023; 42:223-228. [PMID: 37482971 DOI: 10.3233/bd-220056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND Metastases from extramammary malignant neoplasms are very rare, accounting for less than 2% of all breast malignancies. OBJECTIVE The aim of this study is to describe the clinicopathological features and prognosis of breast metastases from non-primary breast malignancies at our institution. METHODS We performed a retrospective observational study, obtaining data from electronic medical records and pathology databases between January 1985 and December 2020 for patients diagnosed with breast metastasis from non-primary breast malignancies. Only patients diagnosed by biopsy were included. RESULTS Fifteen patients diagnosed with breast metastases from non-primary breast malignancies were included, 13 women (86,67%) and 2 men (13,33%). The median age at time of initial diagnosis was 56 years (IQR 21-68). The most frequent primary malignancy was melanoma (9/15; 60%). The median time to diagnosis of breast metastases was 65 months (IQR 13-106). The most common diagnostic modality was CT-scan (10/15; 66,67%). The median follow-up was 96 months (IQR 29-136). Eight patients underwent surgery (53,3%), being the most common surgical intervention breast-conserving surgery (5/8; 62,5%). Mortality at the end of follow-up was 53,3% (8/15). On the survival analysis, we found no differences between patients undergoing surgery and those only receiving systemic treatment [41,5 months (IQR 17,5-57,5) versus 14 months (IQR 2-24), respectively; p = 0,161]. CONCLUSIONS Breast metastases from non-primary breast malignancies are extremely rare and represent a diagnostic and therapeutic challenge, due to the poor prognosis of these patients. Thus, arriving at the correct diagnosis is crucial to avoid unnecessary treatment in this population.
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Affiliation(s)
| | - Luz Divina Juez Sáez
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Belén Pérez Mies
- Pathology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Sara Corral Moreno
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Sonia Rivas Fidalgo
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Jacobo Cabañas Montero
- General and Digestive Surgery Department, University Hospital Ramón y Cajal, Madrid, Spain
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8
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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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9
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Wang B, Jiang Y, Li SY, Niu RL, Blasberg JD, Kaifi JT, Liu G, Wang ZL. Breast metastases from primary lung cancer: a retrospective case series on clinical, ultrasonographic, and immunohistochemical features. Transl Lung Cancer Res 2021; 10:3226-3235. [PMID: 34430360 PMCID: PMC8350075 DOI: 10.21037/tlcr-21-542] [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: 04/15/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022]
Abstract
Background Lung cancer metastases to the breast are less common and consequently have received much less attention in clinical practice. The purpose of this study was to provide a better understanding of clinical, ultrasonographic, and immunohistochemical features of breast metastases from primary lung cancer. Methods This retrospective case series included patients with breast metastases from primary lung cancer between January 2012 and December 2020. Clinical features, ultrasonographic characteristics, and immunohistochemical findings were evaluated in this analysis. Results In all, 7 cases (mean ± standard deviation age: 57.4±8.3 years; range, 49–70 years) were evaluated. The maximum size of breast lesions in 6 cases ranged from 1.2 to 4.5 cm, while 1 case showed a diffused pattern. Ultrasound features of breast metastases from lung cancer were irregular (5/7, 71.4%), indistinct (6/7, 85.7%), hypoechoic (7/7, 100.0%), and parallel (6/7, 85.7%) masses without calcification. Immunohistochemical staining test was positive for thyroid transcription factor 1 (TTF-1) in all patients (7/7, 100.0%), 3 cases (3/5, 60.0%) were negative for p63, 5 cases (5/5, 100.0%) were positive for cytokeratin 7 (CK7), 4 cases (4/5, 80.0%) were positive for napsin A. Conclusions The ultrasonographic features of lung metastases to the breast are clinically important to understand. A known history of the primary lung cancer is of great importance when evaluating patients with a breast nodule. The presence of an ipsilateral lung cancer, breast nodule and axillary lymphadenopathy should be considered with pathological and immunohistochemical data to differentiate breast metastases from a primary breast malignancy in this setting.
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Affiliation(s)
- Bo Wang
- Department of Ultrasound, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ying Jiang
- School of Medicine, Nankai University, Tianjin, China
| | - Shi Yu Li
- Department of Ultrasound, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Rui Lan Niu
- Department of Ultrasound, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Justin D Blasberg
- Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Jussuf T Kaifi
- Division for Cardiothoracic Surgery, Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA
| | - Gang Liu
- Department of Radiology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhi Li Wang
- Department of Ultrasound, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
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10
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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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11
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Systemic diseases affecting the breast: Imaging, diagnosis, and management. Clin Imaging 2021; 77:76-85. [PMID: 33652268 DOI: 10.1016/j.clinimag.2021.02.021] [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: 01/09/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions. This review aims to discuss the clinical presentations, imaging features, pathologic findings, and management of systemic conditions that may affect the breast.
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12
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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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13
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Population screening detected non-lymphomatous non-mammary metastases to the breast. A radiology multimodality pictorial essay. Clin Imaging 2021; 74:156-162. [PMID: 33607596 DOI: 10.1016/j.clinimag.2021.02.004] [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] [Received: 08/10/2020] [Revised: 12/24/2020] [Accepted: 02/02/2021] [Indexed: 11/23/2022]
Abstract
This pictorial essay is a presentation of imaging appearances of non-mammary cancer metastases to the breast detected in asymptomatic women attending BreastScreen Western Australia (BSWA) from 2005 to 2019. Haematological malignancies were excluded. Thirteen cases of histologically proven extramammary metastases to breast were identified from the BSWA data base. Five cases were ovarian cancer metastases, 3 melanoma metastases, 2 of adenocarcinoma metastases with foregut primary and one each of endometrial, renal and carcinoid metastases. Metastasis to breast commonly presented as circumscribed masses (N = 12) at mammography and as hypoechoic masses (N = 10) at ultrasound with a predilection to upper outer quadrant of breast. Metastases to breast from non-mammary primary while a rare occurrence in a breast screening program, may be the first clinical presentation of malignancy in asymptomatic women.
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14
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Feki J, Boudawara O, Makni S, Sellami-Boudawara T, Khanfir A. An uncommon breast metastasis of mediastinal neuroblastoma within a child: A case report. Breast J 2021; 27:377-379. [PMID: 33472272 DOI: 10.1111/tbj.14162] [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] [Received: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
A 13-year-old girl presented with dull lumbar pain and recent paraplegia. Clinical examination found a breast mass associated with an axillary adenopathy. Imaging revealed a large mass in the posterior mediastinum with spinal cord compression. Histological analysis confirmed the diagnosis of neuroblastoma with mammary metastases. To the best of our knowledge, breast metastasis is being reported for the first time in a mediastinal neuroblastoma.
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Affiliation(s)
- Jihene Feki
- Medical Oncology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Olfa Boudawara
- Medical Oncology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Saadia Makni
- Pathology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | | | - Afef Khanfir
- Medical Oncology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
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15
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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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16
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Wang J, Wang B. <p>Metastasis of Ovarian Cancer to Breast: A Case Report and Review of Imaging Manifestations</p>. Cancer Manag Res 2020; 12:13015-13021. [PMID: 33376395 PMCID: PMC7755876 DOI: 10.2147/cmar.s280795] [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: 09/09/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
Abstract
Metastasis of ovarian cancer to breast (MOCB) is rare, and the diagnosis is difficult due to the varied imaging manifestations. The objective of this paper is to report a special case of MOCB, review the imaging manifestations of MOCB and attempt to determine the characteristic imaging features that might be helpful in making the diagnosis and providing appropriate systemic therapy. A 40-year-old woman presented with a breast lesion six years after a diagnosis of ovarian serous cystadenocarcinoma. Ultrasound (US) and magnetic resonance imaging (MRI) examinations were performed; the final diagnosis was metastasis of ovarian serous cystadenocarcinoma to breast according to the histological examination and immunohistochemical examination after lumpectomy. Herein, we reviewed 41 cases diagnosed with MOCB, which include imaging of the metastatic breast lesion or a detailed description without imaging. In this review, we summarized that MOCB could present with calcifications (especially microcalcifications) on mammography (MM). MOCB presenting as inflammatory breast cancer usually shows swelling and skin thickening on MM and US, and increased fludeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT). These manifestations could be helpful in differentiating malignant tumors from benign ones, but it may still be difficult to distinguish between primary and metastatic tumors. The correct diagnosis of MOCB requires a combination of the clinical history of the primary tumor, careful clinical examination, radiology and anatomic pathological evaluation.
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Affiliation(s)
- Jing Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang310003, People’s Republic of China
- Correspondence: Jing Wang Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, Zhejiang310003, People’s Republic of ChinaTel/Fax +86 571 8723 6628 Email
| | - Baohua Wang
- Department of Ultrasound, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang310003, People’s Republic of China
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17
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Wan X, Zhang H, Zhang Y, Peng Y. Metastases to the Breast from Extramammary Nonhematological Malignancies: Case Series. Int J Gen Med 2020; 13:1105-1114. [PMID: 33209053 PMCID: PMC7670084 DOI: 10.2147/ijgm.s276602] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/21/2020] [Indexed: 02/05/2023] Open
Abstract
Objective This article aims to provide a better understanding of ultrasonography and immunohistochemistry of secondary nonhematological tumors of breast. Methods The study reviewed the ultrasound findings and immunohistochemical features of nonhematological metastatic breast tumor cases found in patients of West China Hospital, Sichuan University from 2007 to 2019. Each case was categorized as secondary breast malignancy using histopathological results. Results Fourteen cases were identified from West China Hospital database. Ten cases originated in the lung, 2 cases in the stomach, 1 case in the ovary and 1 case of neuroendocrine carcinomas. Fourteen masses were evaluated. Ultrasound findings showed that tumors were hypoechoic (14/14), irregular (13/14), indistinct margin (13/14), along a long axis parallel to the skin (11/14), lacked vascularity via color doppler flow imaging (9/14). Eight cases showed no posterior features. Calcification was found in 1 case of lung adenocarcinoma that had metastasized to the breast. Abnormal axillary lymph nodes were detected in 5 cases. Immunohistochemical analysis showed that estrogen receptor (ER) and progesterone receptor (PR) were both negative in 11 cases, including gastric and lung cancer metastasis. One case of ovarian metastasis was positive for ER and negative for PR. Six patients were positive for cytokeratin 7 (CK7) and negative for cytokeratin 20 (CK20), including lung and ovarian carcinoma metastasis. Thyroid transcription factor-1 (TTF-1) was positive in 9 of 10 pulmonary carcinoma metastases. The patient of ovarian metastasis was positive for Wilms' tumour 1 (WT-1) and carbohydrate antigen 125 (CA125). Two cases from gastric metastasis were positive for caudal-type homeobox 2 (CDX2). Conclusion Although breast ultrasound is not useful in distinguishing metastases from primary breast cancer, it is helpful in diagnosing breast lesions as oncological diseases and provide evidence for further examination of patients. Immunohistochemistry plays an important role in distinguishing secondary breast cancer from primary, especially in patients without tumor history.
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Affiliation(s)
- Xue Wan
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Heqing Zhang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yahan Zhang
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yulan Peng
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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18
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Chan KH, Lee CH, Sharif SZ, Hayati F, Sallapan S. Diagnostic challenge in diagnosing bilateral breast metastases from mediastinal neuroendocrine tumor: A case report. Ann Med Surg (Lond) 2020; 60:438-441. [PMID: 33251002 PMCID: PMC7683178 DOI: 10.1016/j.amsu.2020.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background Metastatic neuroendocrine tumours (NETs) to the breast are very rare entities. Case presentation A 26-year-old lady presented with anterior neck swelling with symptoms of superior vena cava syndrome for 6 months. Imaging study revealed a mediastinal mass which was preceded with core biopsy which was consistent with high-grade small cell NETs. Despite second-line adjuvant chemotherapy and radiotherapy, her disease became advanced which was confirmed via restaging scan. There were bilateral breast lesions discovered during the scan which was deemed to be metastatic NETs histologically. Despite prompt initiation of treatment, she succumbed 1 year after the radiotherapy due to disease progression. Conclusion High suspicion of an index is needed for diagnosis when patients with known primary NETs present with suspicious breast lesions. Triple assessment is mandatory, however histopathology assessment and immunohistochemistry staining are the mainstay of diagnosis. Metastatic breast neuroendocrine tumours are very rare entities especially when they arise from the mediastinum. High suspicion of an index is needed for diagnosis when patients with known primary neuroendocrine tumours presented with suspicious breast lesions. Any breast pathology requires a triple assessment including secondary breast neuroendocrine tumours.
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Affiliation(s)
- Kheng Hooi Chan
- Department of Surgery, Hospital University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Chang Haur Lee
- Department of Breast and Endocrine Surgery, Queen Elizabeth Hospital 2, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Siti Zubaidah Sharif
- Department of Breast and Endocrine Surgery, Queen Elizabeth Hospital 2, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Corresponding author.
| | - Sugunah Sallapan
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
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19
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Ferrari F, Ficarelli S, Forte S, Valenti G, Ardighieri L, Sartori E, Odicino F. Extra-abdominal ovarian cancer presenting with breast metastases at diagnosis: Case report and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 255:211-221. [PMID: 33152565 DOI: 10.1016/j.ejogrb.2020.10.004] [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: 04/24/2020] [Revised: 08/17/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Malignant ovarian tumours are diagnosed at an advanced stage in the majority of cases. However, only a small percentage present as extra-abdominal, non-lymph-node solid metastases, as in the breast, and they are usually cases of relapse. The discovery of mono- or bilateral breast lesions with peritoneal carcinosis and/or abdomino-pelvic lesions can be cumbersome in the differential diagnosis of primary tumours. This article aims to summarize current evidence on the detection of breast metastases at diagnosis of ovarian cancer. STUDY DESIGN A systematic review of the literature in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including case reports and case series, was undertaken. Data regarding study features; population characteristics; clinical, radiological and histological assessment of the disease; treatment and follow-up were collected. In addition, a case report of a patient managed at the authors' centre is provided. RESULTS According to the search strategy, 16 articles (18 patients) were included in this review. Serous ovarian, fallopian tube or primary peritoneal cancer was detected in 61% of cases, while another type or a non-specified type of epithelial ovarian cancer was detected in 27.7% of cases; there was one case with granulosa cell tumour of the ovary and one case with mucinous ovarian tumour of low malignant potential. Breast metastases were mainly monolateral (66.6%), with other extra-abdominal sites of disease in the majority of the cases. A minority of patients (16.6%) received treatment for primary breast cancer with a subsequent diagnosis of ovarian cancer. Concomitant breast and abdominal surgery can be an option. PAX8, WT1 and CA125 immunohistochemical staining can aid in differential diagnosis. CONCLUSION Breast metastases of malignant ovarian tumours must be promptly recognized to ensure proper treatment. Specific immunohistochemical analysis can be a decisive assessment in uncertain cases.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy.
| | - Silvia Ficarelli
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Sara Forte
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Gaetano Valenti
- Unit of Gynaecology and Obstetrics, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | - Enrico Sartori
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
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20
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Bella-Cueto MR, Pascua-Solé M, Cano-Palomares A, Cabezuelo-Hernandez MÀ, Escoda-Giralt MR, Barcons-Vilaplana S, Serret-Miralles P, Caral-Vanaclocha C, Guirao-Garriga X, Prats-Lopez J, Medarde-Ferrer M, Aparicio-Rodriguez O, Prenafeta-Moreno M, Bonfill-Abella T, Combalia-Soriano N. Metastatic Renal Cell Neoplasm Within a Papillary Thyroid
Carcinoma as Incidental Finding in an Asymptomatic Patient: a Case Report. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42399-020-00316-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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21
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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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22
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Dong F, Xie X, Wei X, Jiao MM, Duan J, Pan L, Bi L, Fan Z, Yang M. Metastatic serous borderline tumor with micro-invasive ovarian carcinoma presenting as a breast lump: A case report. Medicine (Baltimore) 2020; 99:e19383. [PMID: 32118786 PMCID: PMC7478492 DOI: 10.1097/md.0000000000019383] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Breast metastasis from serous borderline tumor with micro-invasive carcinoma of ovary is a very rare condition. The breast lump as the only clinical presentation is rarely seen in ovarian carcinoma, which may lead to be misdiagnosed, and the mechanism of breast metastasis from ovarian tumors in early stage still needs to be explored. Differentiation from primary breast cancer and extramammary malignancy is crucial because the treatment and prognosis are significantly different. PATIENT CONCERNS A 33-year-old female presented with a painless, movable, 1.0 × 1.0 cm lump in the upper outer quadrant of the right breast for a month. DIAGNOSES Breast metastasis of serous borderline tumor with micro-invasive ovarian carcinoma confirmed by pathology and immunohistochemistry. INTERVENTIONS The patient underwent lumpectomy, bilateral ovarian tumor stripping operation and prophylactic chemotherapy. OUTCOMES No signs of recurrence have been detected in 1.5 years of follow-up. LESSONS Distant metastasis may occur in early stage of ovarian carcinoma. It is important to determine the origin of the primary tumor and develop an effective treatment strategy for patients. Imaging findings and pathological diagnostic criteria are important to accurately differentiate between metastasis and primary breast lesions, which may improve the patient's outcomes.
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Affiliation(s)
| | | | - Xue Wei
- Department of Breast Surgery
| | | | | | | | - Lirong Bi
- Department of Pathology, First Hospital of Jilin University, Changchun, People's Republic of China
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23
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Liang MMS, Teo SY, Gudi M, Lim SH, Win T. Breast Microcalcifications as the Only Imaging Manifestation of Metastatic Serous Peritoneal Adenocarcinoma in the Breast. J Radiol Case Rep 2019; 13:1-10. [PMID: 32184921 PMCID: PMC7060008 DOI: 10.3941/jrcr.v13i10.3769] [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: 11/15/2022] Open
Abstract
We present a case of a 65 year old female with newly diagnosed primary peritoneal serous carcinoma who was found to have indeterminate segmental microcalcifications in the right upper outer quadrant with a mildly enlarged right axillary node on mammogram. There was no associated breast mass on ultrasound. Core biopsy of the right axillary lymph node and right upper outer quadrant breast microcalcifications confirmed the presence of breast metastases at both sites from primary peritoneal serous carcinoma. This case highlights the importance of histopathological correlation of any breast and axillary abnormalities in patient with primary extramammary malignancy. Imaging features of metastatic lesions to the breast are also reviewed.
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Affiliation(s)
- Mary Moon-Sun Liang
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - Sze Yiun Teo
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
| | - Mihir Gudi
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Swee Ho Lim
- KK Breast Centre, KK Women’s and Children’s Hospital, Singapore
| | - Thida Win
- Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
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24
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Alzuhair AM, Gong G, Shin HJ, Lee JW, Lee SB, Kim J, Ko BS, Son BH, Ahn SH, Chung IY. Salivary Duct Cancer Metastasis Mimicking Primary Breast Cancer: A Case Report and Review. J Breast Cancer 2019; 22:653-660. [PMID: 31897339 PMCID: PMC6933031 DOI: 10.4048/jbc.2019.22.e45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022] Open
Abstract
Secondary breast malignancy is a rare occurrence, accounting for less than 2% of all breast malignancies. Salivary duct carcinoma (SDC) metastasizing to the breast has not been reported previously. This report presents the case of a woman who was initially diagnosed with and treated for parotid carcinoma. Two years later, during a follow-up visit, a breast lump was discovered, which was diagnosed as primary breast cancer and managed surgically. After surgery, hematoxylin and eosin and immunohistochemical staining revealed that the breast tumor had the same features as her primary SDC. Here, we present a confusing case of SDC metastasis to the breast that mimicked triple-negative breast cancer.
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Affiliation(s)
- Aisha M Alzuhair
- Department of Surgery, King Faisal University, Al Ahsa, Saudi Arabia.,Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jung Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Hyun Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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25
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Chesebro AL, Rives AF, Shaffer K. Male Breast Disease: What the Radiologist Needs to Know. Curr Probl Diagn Radiol 2019; 48:482-493. [DOI: 10.1067/j.cpradiol.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022]
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26
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Magnoni F, Di Tonno C, Accardo G, Calvello M, Corso G, Sacchini V, Galimberti V, Veronesi P. Breast cancer with rare metastatic manifestation. Future Oncol 2019; 15:2437-2440. [PMID: 31339064 DOI: 10.2217/fon-2019-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Francesca Magnoni
- IEO, European Institute of Oncology, IRCCS, Division of Breast Cancer Surgery, Milan, Italy
| | - Clementina Di Tonno
- IEO, European Institute of Oncology, IRCCS, Division of Pathology, Milan, Italy
| | - Giuseppe Accardo
- IEO, European Institute of Oncology, IRCCS, Division of Breast Cancer Surgery, Milan, Italy
| | - Mariarosaria Calvello
- IEO, European Institute of Oncology, IRCCS, Division of Cancer Prevention & Genetics, Milan, Italy
| | - Giovanni Corso
- IEO, European Institute of Oncology, IRCCS, Division of Breast Cancer Surgery, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - Virgilio Sacchini
- IEO, European Institute of Oncology, IRCCS, Division of Breast Cancer Surgery, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
| | - Viviana Galimberti
- IEO, European Institute of Oncology, IRCCS, Division of Breast Cancer Surgery, Milan, Italy
| | - Paolo Veronesi
- IEO, European Institute of Oncology, IRCCS, Division of Breast Cancer Surgery, Milan, Italy.,Faculty of Medicine, University of Milan, Milan, Italy
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27
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Pesce K, Chico M, Sanabria Delgado J, Zabala Sierra A, Hadad C, Wernicke A. Metastases to the breast, an uncommon diagnosis: What do radiologists need to know? RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Metastases to the breast, an uncommon diagnosis: what do radiologists need to know? RADIOLOGIA 2019; 61:324-332. [PMID: 30981417 DOI: 10.1016/j.rx.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze the imaging characteristics of histologically diagnosed metastases to the breast. MATERIAL AND METHODS We selected patients histologically diagnosed with metastases to the breast in our diagnostic and interventional breast imaging unit between March 2010 and September 2018. RESULTS A total of 9 patients (all women; mean age, 60 y; age range, 28-89 y) were diagnosed with metastases to the breast. In 1 (11.11%) case, the primary disease was diagnosed from the breast lesion. The primary tumors were melanoma (n=5), neuroendocrine tumor (n=2, one from the small bowel and one from the cervix), lung adenocarcinoma (n=1), and ovarian cancer (n=1). The clinical and imaging manifestations depend on the type of dissemination of disease and can simulate benign and malignant primary breast lesions. CONCLUSION There is no specific imaging pattern for metastases to the breast that would help to orient the diagnosis. It is important to consider this etiological possibility if the patient has a history of a primary tumor in another organ.
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29
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A Case Series of Breast Metastases from Different Extramammary Malignancies and Their Literature Review. Case Rep Radiol 2019; 2019:9454201. [PMID: 30729058 PMCID: PMC6341250 DOI: 10.1155/2019/9454201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/21/2018] [Accepted: 12/23/2018] [Indexed: 12/19/2022] Open
Abstract
Metastasis to the breast from all other primary sites is unusual. Twelve patients were diagnosed between 2007 and 2017 at National Cancer Institute, Mexico. Solitary or multiple masses, round or oval, and hypoechoic and solid lesions with posterior acoustic shadowing were patterns commonly reported in these patients; other arrangements include diffuse involvement of the breast simulating an inflammatory carcinoma. The development of a breast metastasis is revealed, in our experience, as a negative prognostic factor. Thus, the radiologist should know about the varied appearance of metastatic breast lesions and provide radiopathological correlations when available.
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30
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Breast Arterial Calcification in the Mammogram Report: The Patient Perspective. AJR Am J Roentgenol 2019; 212:209-214. [DOI: 10.2214/ajr.18.20171] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Breast metastasis from ovarian cancer: A case report. Radiol Case Rep 2018; 13:1166-1169. [PMID: 30233752 PMCID: PMC6138944 DOI: 10.1016/j.radcr.2018.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/04/2018] [Accepted: 08/12/2018] [Indexed: 11/28/2022] Open
Abstract
Breast metastasis from ovarian cancer is a rare event, with vary clinical and imaging presentations, depends on the form of dissemination of the disease and may mimic primary benign and malignant lesions.Confirmation of the diagnosis is of pivotal importance to choice an adequate therapeutic planning, allowing to avoid unnecessary surgeries and to provide appropriate systemic therapy. In this manuscript, we present a case of breast metastasis from ovarian cancer. The patient presented to our Institute with a localized, palpable mass in the upper outer quadrant of the right breast. Mammography and breast sonography showed a singular, round, and homogenous mass with regular borders. No suspicious axillary node was observed. Lesion biopsy revealed the presence of epithelial malignant tumor cells, compatible with a tube-ovarian serous histotype. So, although it could be rare, secondary malignant neoplasm should be considered in the differential diagnosis of breast lesions in patients with a personal history of ovarian cancer.
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32
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Whorms DS, Fishman MDC, Slanetz PJ. Mesenchymal Lesions of the Breast: What Radiologists Need to Know. AJR Am J Roentgenol 2018; 211:224-233. [PMID: 29792741 DOI: 10.2214/ajr.17.19020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Mesenchymal breast tumors originate from the various components of mammary stroma. The aim of this review is to discuss the clinical presentation, imaging appearance, and management of mesenchymal breast lesions. CONCLUSION Although many mesenchymal tumors exhibit characteristic findings on imaging, others show nonspecific characteristics and require tissue biopsy for diagnosis. An awareness of the clinical and imaging presentation is essential in guiding the differential diagnosis and patient management.
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Affiliation(s)
- Debra S Whorms
- 1 Harvard Medical School, 25 Shattuck St, Boston, MA 02215
| | - Michael D C Fishman
- 1 Harvard Medical School, 25 Shattuck St, Boston, MA 02215
- 2 Department of Radiology, Division of Breast Imaging, Beth Israel Deaconess Medical Center, Boston, MA
- 3 Present address: Department of Radiology, Division of Breast Imaging, Boston Medical Center, Boston, MA
| | - Priscilla J Slanetz
- 1 Harvard Medical School, 25 Shattuck St, Boston, MA 02215
- 2 Department of Radiology, Division of Breast Imaging, Beth Israel Deaconess Medical Center, Boston, MA
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33
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Hawley JR, Kang-Chapman JK, Bonnet SE, Kerger AL, Taylor CR, Erdal BS. Diagnostic Accuracy of Digital Breast Tomosynthesis in the Evaluation of Palpable Breast Abnormalities. Acad Radiol 2018; 25:297-304. [PMID: 29174225 DOI: 10.1016/j.acra.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The role of digital breast tomosynthesis (DBT) in evaluating palpable abnormalities has not been evaluated and its accuracy compared to 2D mammography is unknown. The purpose of this study was to evaluate combined 2D mammography, DBT, and ultrasound (US) at palpable sites. MATERIALS AND METHODS Two breast imagers reviewed blinded consecutive cases with combined 2D mammograms and DBT examinations performed for palpable complaints. By consensus, 2D and DBT findings were recorded and compared to US. Patient characteristics, demographics, subsequent workup, and outcome were recorded. RESULTS A total of 229 sites in 188 patients were included, with 50 biopsies performed identifying 18 cancers. All 18 cancers were identified on 2D and US, whereas 17 cancers were identified on DBT. Cancer detection sensitivities for 2D, DBT, and US were 100.0%, 94.4%, and 100.0%. The negative predictive value, when combined with US, was 100% for both. The sensitivity and the specificity for both benign and malignant findings with 2D and DBT were 70.5% versus 75.4% (P = 0.07) and 95.3% versus 99.1% (P = 0.125). Palpable findings not identified by 2D and DBT were smaller than those identified (11.5 ± 8.3 mm vs 23.9 ± 12.8 mm, P < 0.001). Patients with dense breasts were more likely to have mammographically occult findings than patients with nondense breasts (27.4% vs 8.3%). CONCLUSIONS DBT did not improve cancer detection over 2D or US. Both mammographic modalities failed to identify sonographically confirmed findings primarily in dense breasts. The diagnostic use of DBT at palpable sites provided limited benefit over combined 2D and US. When utilizing DBT, US should be performed to adequately characterize palpable sites.
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Sun P, Chen J, Lu J, Luo R, Li M, He J. Characteristics of breast metastases from non-breast solid tumors in 22 patients from a southern Chinese population. Oncol Lett 2018; 15:3685-3693. [PMID: 29467888 PMCID: PMC5795931 DOI: 10.3892/ol.2018.7741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/07/2017] [Indexed: 11/06/2022] Open
Abstract
Breast metastases from solid non-breast tumor types are rare; however, they should be always considered in the differential diagnosis of a breast lesion owing to the associated poor patient prognosis and the requirement of different therapeutic strategies compared with those used to treat primary breast cancer. The aim of the current study was to summarize the characteristics of metastases to the breast in a southern Chinese population. The medical records and pathological sections of 22 patients with pathologically confirmed extra-mammary metastases to the breast that presented to Sun Yat-sen University Cancer Center between January 2000 and December 2015 were retrospectively reviewed. The median age of onset for breast metastasis was 43 years (range, 10-62 years) and 19 (86.4%) patients had a known history of a primary tumor. The mean interval from diagnosis of the primary tumor to breast metastasis was 16.5 months (range, 6-56 months). A unilateral (45.5% left, 36.4% right), upper outer quadrant (15/22, 68.2%) lesion of the breast was most frequently initially detected by self-checking (63.6%). The most common origin of the primary tumor was the lung (22.7%). Nasopharyngeal carcinoma accounted for a high proportion of the metastases (18.2%). The median duration of survival from the time of diagnosis of a breast metastasis was 14 months (range, 2-74 months). A total of 10 patients (45.5%) succumbed to the disease. The results also indicated that overall survival in patients that underwent surgery was improved compared with patients who did not undergo surgery. The results of the present study demonstrated that clinical history, imaging findings, pathology from the primary tumor and immunostaining were required in combination to establish an accurate diagnosis. Further investigation into the improvement of the prognosis of patients with metastases to the breast following surgery is required.
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Affiliation(s)
- Peng Sun
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Jiewei Chen
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Jiabin Lu
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Rongzhen Luo
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Mei Li
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
| | - Jiehua He
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510080, P.R. China
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Magee AL, Dashevsky BZ, Jahangir K, Kulkarni K. Incidental focal uptake in the breast and axilla on FDG PET: Clinical considerations and differential diagnosis. Clin Imaging 2017. [DOI: 10.1016/j.clinimag.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Bitencourt AGV, Gama RRM, Graziano L, Negrão EMS, Sabino SMPS, Watanabe AHU, Guatelli CS, Souza JA, Mauad EC, Marques EF. Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol 2017; 90:20170197. [PMID: 28485985 DOI: 10.1259/bjr.20170197] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast metastases from extramammary cancers are rare and usually related to poor prognosis. The extramammary tumours most frequently exhibiting breast metastases are melanoma, lymphomas, ovarian cancer, lung and neuroendocrine tumours, and sarcomas. Owing to the lack of reliable and specific clinical or radiological signs for the diagnosis of breast metastases, a combination of techniques is needed to differentiate these lesions from primary breast carcinoma or even benign breast lesions. Multiple imaging methods may be used to evaluate these patients, including mammography, ultrasound, MRI, CT and positron emission tomography CT. Clinical and imaging manifestations are varied, depend on the form of dissemination of the disease and may mimic primary benign and malignant breast lesions. Haematologically disseminated metastases often develop as a circumscribed mass, whereas lymphatic dissemination often presents as diffuse breast oedema and skin thickening. Unlike primary carcinomas, breast metastases generally do not have spiculated margins, skin or nipple retraction. Microlobulated or indistinct margins may be present in some cases. Although calcifications are not frequently present in metastatic lesions, they occur more commonly in patients with ovarian cancer. Although rare, secondary malignant neoplasms should be considered in the differential diagnosis of breast lesions, in the appropriate clinical setting. Knowledge of the most common imaging features can help to provide the correct diagnosis and adequate therapeutic planning.
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Affiliation(s)
| | - Roberta R M Gama
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Luciana Graziano
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Erika M S Negrão
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Silvia M P S Sabino
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Anapaula H U Watanabe
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Camila S Guatelli
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Juliana A Souza
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Edmundo C Mauad
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Elvira F Marques
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
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