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Ding J, Gu H, Yang Z, Lu Y, Guo G. Breast metastasis from lung adenocarcinoma: a case report and review of the literature. Front Oncol 2024; 14:1370453. [PMID: 38841167 PMCID: PMC11150669 DOI: 10.3389/fonc.2024.1370453] [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] [Received: 01/14/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Lung cancer (LC) is one of the most lethal and most prevalent malignant tumors, and lung adenocarcinoma (LUAD) is the most common pathological type of lung cancer. Breast cancer (BC) is the most common cancer worldwide, but metastases to the breast from extramammary neoplasms are rare, especially from the lung. Early diagnosis and differentiation of primary from metastatic breast carcinoma are essential. Here, we present a case of metastases to the breast from lung adenocarcinoma, the treatment options varied according to disease progression.
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Affiliation(s)
| | | | | | | | - Guilong Guo
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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2
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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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Lee AHS, Hodi Z, Soomro I, Sovani V, Abbas A, Rakha E, Ellis IO. Histological clues to the diagnosis of metastasis to the breast from extramammary malignancies. Histopathology 2020; 77:303-313. [PMID: 32396659 DOI: 10.1111/his.14141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
AIMS The aims of this study were to review the histological features useful for the identification of metastases to the breast and to investigate the impression that this diagnosis has become more common. METHODS AND RESULTS The histological features of metastases to the breast from 2008 to 2018 were reviewed. Seventy-four biopsies from 66 patients were identified: 1% compared with primary carcinoma of the breast. Non-haematological metastases comprised 0.75% compared with 0.3% in a series from 1996 to 2005. The most common tumour types were pulmonary carcinoma (22), lymphoma (15), melanoma (13), gastrointestinal carcinoma (eight) and serous papillary carcinoma (four). In 73% there were histological features that were not typical of primary mammary carcinoma. Some metastases were histologically similar to breast cancer and the history was essential to making the correct diagnosis. Useful histological clues included small-cell morphology for pulmonary carcinoma, glands containing necrosis for gastrointestinal carcinoma, intranuclear inclusions, marked pleomorphism and spindle cells for melanoma, clear cells for renal carcinoma, papillary architecture for serous papillary carcinoma and sheets of centroblasts or nodules of centroblasts and centrocytes for lymphoma. Useful immunohistochemical markers included TTF-1 for pulmonary carcinoma, S100, melan-A and HMB45 for melanoma, CK20 and CDX2 for colorectal carcinoma, PAX8 and WT1 for serous papillary carcinoma and lymphoid markers for lymphomas, in addition to the absence of expression of mammary markers ER, GATA3 and GCDFP-15. CONCLUSION The majority of metastases to the breast have histological clues to the diagnosis. Immunohistochemistry is helpful. This diagnosis is being made more frequently.
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Affiliation(s)
- Andrew H S Lee
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
| | - Zsolt Hodi
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
| | - Irshad Soomro
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
| | - Vishakha Sovani
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
| | - Areeg Abbas
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
| | - Emad Rakha
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
| | - Ian O Ellis
- Department of Histopathology, Nottingham University Hospitals, City Hospital Campus, Nottingham, UK
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Tomasini C. Cytotoxic-mediated spontaneous regression of inflammatory cutaneous metastases of breast carcinoma. J Cutan Pathol 2020; 47:758-763. [PMID: 32222990 DOI: 10.1111/cup.13694] [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: 09/26/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 12/29/2022]
Abstract
Spontaneous regression (SR) of cancer is a rare but well-documented biological phenomenon, which is even rarer in the context of metastatic breast carcinoma. Different mechanisms of SR are still under debate, including immune-mediated response. We herein report a case of the SR of intralymphatic cutaneous metastases of a breast carcinoma with spontaneously-induced T-cell-mediated cytotoxic response. An 86-year-old female was diagnosed with locally advanced right breast carcinoma and axillary lymph node metastases, without distant metastases The patient refused any therapy. Six months afterwards, she developed multiple, asymptomatic purpura-like plaques with prominent teleangectasias on her right chest wall, continuous to the previous surgical scar and on her ipsilateral abdomen. Skin biopsy showed aggregates of atypical cells admixed with erythrocyte thrombi within dilated dermal lymphatic vessels. SR of the cutaneous lesions occurred within 6 months and persisted at the 15 months follow-up in the absence of therapy, whilst no signs of internal relapse were observed. Immunohistochemically, the estrogen-negative, CK7-positive, C-erb B2-positive intralymphatic metastases were associated with extensive infiltration of CD8-positive cytototoxic T lymphocytes. Factors that may have precluded the implantation of intralymphatic metastases leading to SR are discussed, with local immune surveillance being one major hypothesis.
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Affiliation(s)
- Carlo Tomasini
- IRCCS Fondazione Policlinico San Matteo, Department of Medical-Surgical, Diagnostic and Pediatric Sciences, Dermatologic Clinic, University of Pavia School of Medicine, Pavia, Italy
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Enrico D, Saucedo S, Bravo I. Breast metastasis from primary lung adenocarcinoma in a young woman: A case report and literature review. World J Clin Oncol 2019; 10:269-278. [PMID: 31396476 PMCID: PMC6682499 DOI: 10.5306/wjco.v10.i7.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/25/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast metastasis from extra mammary malignancies is rare. An incidence of 0.2%-1.3% has been reported in the literature, including that from different types of malignant neoplasms.
CASE SUMMARY We present a case of a 29-year-old nonsmoking woman with breast metastasis from lung adenocarcinoma. Computed tomography revealed atelectasis in the right middle lobe of the lung and ipsilateral pleural effusion. Additionally, on physical examination, a small mass was noted in her right breast. The patient underwent bronchoscopy, needle thoracentesis, and breast biopsy. Following cytology, histology and immunohistochemistry, primary lung adenocarcinoma with metastasis to the breast was diagnosed. Only 63 cases, including our patient, have been reported in the literature since 2000, and this is the second in a woman under 30 years of age.
CONCLUSION This atypical presentation may cause a significant diagnostic dilemma, but the contribution of immunohistochemistry is crucial to the accuracy of the final diagnosis.
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Affiliation(s)
- Diego Enrico
- Department of Clinical Oncology, Eva Perón General Hospital, 3200 Balbín Avenue, San Martín 1650, Buenos Aires, Argentina
| | - Silvia Saucedo
- Department of Pathology, Eva Perón General Hospital, 3200 Balbín Avenue, San Martín 1650, Buenos Aires, Argentina
| | - Inés Bravo
- Department of Pathology, Eva Perón General Hospital, 3200 Balbín Avenue, San Martín 1650, Buenos Aires, Argentina
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Ota T, Hasegawa Y, Okimura A, Sakashita K, Sunami T, Yukimoto K, Sawada R, Sakamoto K, Fukuoka M. Breast metastasis from EGFR-mutated lung adenocarcinoma: A case report and review of the literature. Clin Case Rep 2018; 6:1510-1516. [PMID: 30147894 PMCID: PMC6098998 DOI: 10.1002/ccr3.1636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/16/2018] [Indexed: 12/14/2022] Open
Abstract
Although lung cancer rarely metastasizes to the breast, we report a case of breast metastasis from lung adenocarcinoma harboring an epidermal growth factor receptor mutation. This breast metastasis was initially considered recurrent breast cancer and was later diagnosed based on histopathological and molecular examinations as metastasis from lung cancer.
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Affiliation(s)
- Takayo Ota
- Department of Medical OncologyIzumi City General HospitalIzumiOsakaJapan
| | - Yoshikazu Hasegawa
- Department of Medical OncologyIzumi City General HospitalIzumiOsakaJapan
| | - Akira Okimura
- Department of PathologyIzumi City General HospitalIzumiOsakaJapan
| | | | - Takeshi Sunami
- Department of SurgeryIzumi City General HospitalIzumiOsakaJapan
| | | | - Ryugo Sawada
- Department of SurgeryIzumi City General HospitalIzumiOsakaJapan
| | | | - Masahiro Fukuoka
- Department of Medical OncologyIzumi City General HospitalIzumiOsakaJapan
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