Breast Metastasis From Castrate-Resistant Prostatic Adenocarcinoma Mimicking as a Second Primary: A Case Report

The occurrence of breast metastasis from prostate carcinoma and primary breast carcinoma in men may cause a diagnostic dilemma. This report aims to present a patient diagnosed with metastatic castrate-resistant prostatic adenocarcinoma who developed breast metastasis mimicking as a second primary. A 57-year-old male patient presented with a breast mass while undergoing hormonal therapy for prostatic adenocarcinoma. The initial histopathologic diagnosis of the breast specimen was an infiltrating ductal breast carcinoma. The breast mass enlarged after four cycles of docetaxel. Immunostaining with prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP) was done on the breast specimen revealing a negative PSA and a moderately staining PSAP. These stains confirmed the diagnosis of a breast metastasis from prostatic adenocarcinoma. The differentiation between primary breast carcinoma and breast metastasis from prostate carcinoma is crucial. Hence, immunohistochemistry staining should be utilized for diagnosis and appropriate management.

Cutaneous Metastases: A Review and Diagnostic Approach to Tumors of Unknown Origin

CONTEXT.—

Cutaneous metastases from a distant malignancy are a diagnostic challenge for pathologists. Secondary involvement of the skin by a metastatic process portends a much worse clinical prognosis than any primary cutaneous malignant mimickers. Immunohistochemical staining methods continue to evolve and are of paramount importance in diagnosis.

OBJECTIVE.—

To review the clinical, histopathologic, and immunohistochemical staining patterns for commonly encountered entities and discuss potential pitfalls in diagnosis. A practical guide useful in approaching cutaneous metastases of unknown primary is outlined.

DATA SOURCES.—

An extensive search and review of literature in PubMed was performed, processed, and condensed.

CONCLUSIONS.—

Cutaneous metastases have broad histopathologic patterns. They are nearly always dermal based, with an overall foreign appearance. They can be single papules/nodules or multiple in number, mimicking an inflammatory or infectious process. Ultimately, immunohistochemistry remains an essential diagnostic tool, and clinical correlation is paramount in the workup of these entities.

Prostate Cancer: Cases of Rare Presentation and Rare Metastasis

Prostate cancer is the second most common cancer in men. Diagnosis of early disease is based on prostate biopsy which is carried out because of symptoms of prostatism or asymptomatic rise in PSA. On the other side, advanced disease can locally invade and metastasise to lymph nodes, bones, lungs, etc. Initial presentation of prostate cancer in form of brain metastasis is extremely seldom. Similarly, prostate cancer, which metastasised to the breast, is very rare too. Here, we discuss two unique cases of prostate cancer, one of them had an initial presentation of brain metastasis from prostate adenocarcinoma and the other case had an established diagnosis of prostate cancer metastasised to the breast. In theory, cancer can cause metastatic spread to any part of the body; however diversity into such presentation or progression from prostate cancer has not been frequently noticed.

Recurrence of prostate cancer with cutaneous metastasis after radical prostatectomy

While cutaneous metastases are already extremely rare in primary metastatic prostatic adenocarcinoma, cutaneous manifestations in recurrent prostate cancer have rarely been described prior to this report. Here we present the case report of a 93-year-old male who underwent radical prostatectomy but eventually suffered from a previously undescribed recurrence of prostatic adenocarcinoma with distant cutaneous metastases to proximal right lower leg.

Magnetic resonance imaging features of inflammatory breast metastasis from gastric signet-ring cell carcinoma

This report presents a rare case of inflammatory breast metastasis from gastric signet-ring cell carcinoma. The clinical and radiologic findings were similar to those of primary inflammatory carcinoma or acute mastitis. Further, ultrasonography showed diffuse skin thickening and a diffuse infiltrative hypoechoic lesion with marked posterior acoustic shadowing in the left breast. Similarly, magnetic resonance imaging showed diffuse skin thickening/enhancement and a diffuse non-mass-like enhancement in the left breast and to a lesser degree in the right breast.

Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review

Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.

Breast metastasis of a squamous cell carcinoma of the uterine cervix mimicking inflammatory breast cancer

Breast metastases from distant carcinoma are infrequent, and cervix carcinoma is rarely the primary lesion. We describe the first case of a cervical squamous cell carcinoma with breast metastasis mimicking an inflammatory breast cancer in a 74-year-old woman. Seventeen months after the treatment of a primary tumor, the patient developed breast lesions looking like an inflammatory breast tumor. After a 1-year delay due to the patient's refusal, pathological examination and immunohistochemistry confirmed the diagnosis of breast metastasis from a poorly differentiated squamous cell carcinoma. The volume of the breast was huge, associated with axillary lymphadenopathies and multiple lung metastases. Despite platinum-based chemotherapy, the disease progressed and the patient died rapidly, 3 months after the first chemotherapy cycle and 15 months after the first mammary symptoms. We review the literature concerning breast metastases from gynecologic cancers and, particularly, from cervical squamous cell carcinoma. Differential diagnosis of such lesions may be problematic but is essential to avoid unnecessary mutilating surgery and to institute the appropriate systemic therapy. The prognosis is poor.