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Bronchoscopy biopsy. Low differentiated adenocarcinoma with micropapillary component (arrow). (Hematoxylin-eosin, ×100).
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Breast metastasis from extra-mammary malignancy is rare. Based on the literature an incidence of 0.4-1.3% is reported. The primary malignancies most commonly metastasizing to the breast are leukemia-lymphoma, and malignant melanoma. We present a case of metastasis to the breast from a pulmonary adenocarcinoma, with extensive micropapillary componen...
Context in source publication
Context 1
... -Eosin (H&E) stained paraffin sections of the bronchoscopy biopsy demonstrated bronchial muco- sal infiltration by a low differentiated adenocarcinoma. An extensive micropapillary component was identified ( Figure 3). The latter was observed as papillary struc- tures with tufts that lacked a central fibrovascular core. ...Similar publications
Retiform hemangioendothelioma (RH) is a rare low-grade variant of angiosarcoma mostly reported on dermis or subcutaneously. A 30-year-old woman suffering from dry cough, dyspnea and pleural effusion has been described. Distinctive symptoms and lesions on high resolution computed tomography (HRCT) scan and common histological, immunological feature...
Sarcoidosis is a multi-systemic disorder of unknown origin and most commonly affects the lungs. Diagnosis relies on the presence of non-caseating granulomas on histologic specimens. In high-resolution computed tomography, the most characteristic findings are peribronchovascular thickening, perilymphatic nodular distribution, and bilateral hilar ade...
Citations
... 8 Metastatic breast tumors typically manifest as a palpable, rapidly growing, hard, painless, welldefined isolated mass. [9][10][11] It is important to note that skin changes and nipple discharge are extremely rare with metastatic breast tumors. 12,13 Unlike primary breast cancer, with mammography, metastatic breast tumors are characterized as dense, round, and microlobulated masses that may have smooth boundaries. ...
In this article, we present a rare case of breast metastasis of lung cancer. Chest computed tomography (CT) for a woman in her early 50s indicated right lung malignancy, multiple bone metastases, and an irregular mass in her right breast. Further inquiry into the case history revealed that the patient had been aware of the breast mass for 3 years, without respiratory symptoms. Biopsy of the breast mass suggested estrogen receptor (ER) (+), progesterone receptor (PR) (-), and human epidermal growth factor receptor 2 (HER2) (+ +) breast cancer. The patient was initially diagnosed with breast cancer with lung and bone metastasis. However, comprehensive breast cancer treatment was ineffective, and thyroid transcription factor-1 (TTF-1), napsin A, and cytokeratin 7 (CK7) were evaluated to better understand the origin of the cancer. To the best of our knowledge, this patient had the longest reported disease course from presentation with a breast lump as the first symptom to the final diagnosis of breast metastasis of lung cancer. To provide a better reference for differential diagnosis of ambiguous tumors, we also performed a systematic literature review.
... As a result, IHC is crucial for establishing reliable diagnosis. This is achieved with the use of markers, such as TTF-1, Napsin A, and CK7 (39,(41)(42)(43)(44). ...
Metastases to the breast from non-mammary origin are rare. The majority of these lesions appear as secondary manifestations of melanoma and lymphoma, followed by lung carcinomas, gynecological carcinomas, and sarcomas. There has been a steady trend of an increase in diagnosis of intramammary metastases owing to the current advances in imaging technology. Imaging features depend on the type of primary neoplasm and route of dissemination, some of which resemble primary breast cancer and benign breast entities. There are certain imaging features that raise the level of suspicion for metastases in the correct clinical context. However, imaging manifestations of intramammary metastases do not always comply with the known classic patterns. The aim of this review is to clarify these features, emphasizing radiologic-pathologic correlation and a multidisciplinary approach, since most cases are found in patients with advanced disease.
... Therefore, systemic treatment of primary tumors is the main recommended treatment and may help prevent unnecessary operations and longterm postoperative recovery. Other authors have recommended that surgery be avoided because of the short life expectancy of patients and the risk of seeding of cancer cells in the skin (17,34,35). We also found no statistical difference in survival between patients in whom the breast was the only site of metastasis site and those in whom it was not. ...
... However, the relatively small number of patients in this study may be a source of bias. The median length of survival among our patients with breast metastasis was 32 months, which is consistent with findings in previous reports (17,34,35). To have a more comprehensive and in-depth understanding of this disease, further studies with larger populations and longer follow-up would yield more credible and persuasive findings. ...
To discuss the clinicopathological features and prognosis of metastases to the breast from extramammary solid tumors and lymphomas, we reviewed Cancer Hospital of Chinese Academy of Medical Sciences database from 01/01/2000 to 12/31/2020. Fifty-nine patients were identified. The most common primary sites for breast metastases were lymph node and pulmonary, followed by nasal cavity, ovary, skin, etc. All the patients were treated with chemotherapy, 18 were operated, 14 accepted radiotherapy. Metastasis to breast should be considered in any patient with tumor history presenting a breast lump. Pathological with immunohistochemical examination should be performed to identify the original site.
... In addition, most of the patients in our study had ipsilateral axillary lymphadenopathy. This is similar to other studies, which report cases of lung cancer with ipsilateral breast metastasis (14)(15)(16); metastasis to the contralateral breast has also been previously reported (3), but this finding is less common than ipsilateral metastasis. Indeed, only 1 patient in our study had contralateral breast metastasis. ...
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.
... Although superficially located, unlike primary masses, they do not cause skin or nipple retraction. In secondary tumors, spiculation, posterior shadowing, and calcifications usually detected in primary breast cancers are very rare (2,3,7,16). Calcifications have been identified in metastases of ovarian, gastric, thyroid, and mucin-producing gastrointestinal cancers (14). ...
... There were multiple lesions superficially located in the subcutaneous fatty tissue and additional lesions deep in the parenchyma. Tumors that spread through the lymphatic route tend to manifest in the subcutaneous lymphatic channels as skin thickening, subcutaneous edema, and trabecular thickening due to tumor emboli (2). An apparent mass may or may not be present (9,17). ...
... Clinically, peau d'orange and redness on the skin may occasionally be observed. These cases can be falsely diagnosed as mastitis or inflammatory breast cancers (2,4). It has been documented that ovarian, gastric, and lung cancers lead to this type of breast metastases (4,16,19,20). ...
Despite the high prevalence of lung cancer among other primary tumors, metastasis of this particular malignancy in the breast is very rare. We report three new cases of lung cancer with breast metastases and discuss radiological and clinical findings. Radiologically, each case displayed different characteristics. First, one of them had bilateral superficially and deeply located irregular lesions. Second, the patient presented with findings similar to inflammatory breast cancer. The third case had a circumscribed mass, resembling a benign complicated cyst. To guide clinicians for proper patient management, radiologists should be aware of the scope of typical and atypical imaging findings of metastatic involvement of the breast.
... Also noted in our series, metastatic tumors to the breast frequently showed irregular tumor borders and commonly present as a solitary (rather than multicentric) breast mass. The absence of in situ carcinoma strongly supports a metastatic tumor, although it may not occur in all primary invasive carcinomas (22,32). Most researchers agree that calcifications and microcalcifications except for ovarian serous carcinoma are extremely rare and observed only in the patients with metastatic papillary carcinoma with psammoma bodies (32)(33)(34). ...
Background:
Rare extra-mammary metastases of adenocarcinoma to the breast closely mimic primary invasive breast carcinoma (PBC), and specifically without an aware of clinical history, pose a difficult diagnostic issue.
Methods:
With the aim to improve differential diagnosis of lung adenocarcinoma metastasis and primary breast carcinoma in the breast, we retrieved 41 breast metastases from lung adenocarcinoma, seven of which were from the archived pathologic files of Cancer Hospital, Chinese Academy of Medical Science (CHCAMS) between 2001 and 2019, and the other 34 cases were collected from the published literatures. Clinicopathological features were collected and analyzed for differential diagnosis of primary lung malignancy, triple negative breast pathology and breast lesions without ipsilateral axillary lymphadenopathy or with contralateral axillary lymphadenopathy. Supplementary breast (GCDFP-15, or GATA-3) and lung-lineage (TTF-1) immunostaining plus genetic alternation analysis were also recorded and analyzed.
Results:
Among the 41 cases, there were 37 females and four males, with a median age of 63 (range, 40-81) years at diagnosis of the breast lesion. Twenty-four cases (58.5%, 24/41) were detected metachronously to the counterpart of the lung. Strikingly, 13 cases (31.7%, 13/41) were initially misdiagnosed as primary breast cancer, and differential diagnostic factors were compared and analyzed between the correct and misdiagnosed cases, among which a documentation of lung cancer history showed significant difference. Pathologist initially misinterpreted six cases (46.2%, 6/13) as PBC on needle biopsy of breast mass with an unknown lung cancer history. The clinical diagnosis was considered two cases (15.4%, 2/13) to be either a primary breast tumor with lung and pleural metastasis or two synchronous primary tumors. Three cases (23.1%, 3/13) were initially misinterpreted as PBC by breast ultrasonography. TTF-1 immunostaining was found to be critical for a correct diagnosis of metastatic lesion (84.6%, 11/13) from the initially misdiagnosed cases as PBC.
Conclusions:
Metastatic lung adenocarcinoma to the breast, although rare, should be considered in the differential diagnosis of primary breast carcinoma, especially when the breast lesion exhibits as a "triple-negative invasive carcinoma". A documented lung cancer history combined with the clinicoradiological assessment and pathological evaluation are essential to make a correct differential diagnosis. TTF-1 immunostaining is crucial in approaching the diagnosis.
... Metastasis of lung cancer is one of the most difficult problems impacting clinical treatment and affects the prognosis of patients. [7][8][9] Breast metastasis secondary to extramammary malignant tumors is very rare, with an incidence of ∼0.4% to 1.3% in breast cancer cases. [10] Lee et al [11] reported 33 cases of breast metastasis from extramammary malignant tumors, of which the most common primary tumor was gastric cancer. ...
Introduction:
Lung adenocarcinoma is the most common type of lung cancer. Distant metastasis of lung adenocarcinoma often occurs in multiple organs. The common metastasis sites of lung cancer include the lungs, brain, bones, adrenal glands, and lymph nodes; however, breast metastasis is rare.
Patient concerns:
In this report, we describe a case of breast metastasis from lung adenocarcinoma. A 55-year-old woman reported left breast pain for more than 1 month.
Diagnosis:
Based on imaging, pathological examination, and immunohistochemical examination, the diagnosis of breast metastasis from lung adenocarcinoma was confirmed. Epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangement were not detected by next-generation sequencing.
Interventions:
The patient was treated with six courses of a combination of albumin-bound paclitaxel, cisplatin, and bevacizumab over 21 days.
Outcomes:
After six cycles of palliative chemotherapy, her left breast pain and swelling subsided; in addition, her serum CA12-5, CYFRA, and CEA levels normalized by April 2019. PR status was evaluated as per the RECIST 1.1 criteria. The patient developed brain metastases 3 months later and died due to multiple organ failure.
Conclusion:
The possibility of breast metastasis should be considered in patients with existing malignant tumors and breast pain. Clinical and imaging examinations are helpful for diagnosis, and pathological and immunohistochemical analyses are the most important diagnostic tools.
... Metastases to the breast from extramammary carcinoma are rare, especially those deriving from lung cancer [3,4]. In the following study we performed a secondary analysis of baseline data collected from 21 cases with secondary breast metastasis deriving from lung cancer that have been reported in China, including one additional case from our medical record. ...
Background:
To analyze the clinical and molecular characteristics, as well as pathologic diagnosis and treatment of lung tumors that spread to the breast in 22 Chinese patients.
Materials and methods:
A systematic literature search of PubMed, Embase, ScienceDirect, Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Database and Wanfang Databases was conducted to identify the related studies published before March 31, 2020. A case of a 64-year-old man who underwent pneumonectomy and who was eventually diagnosed with a breast lump 5 years after surgery at our hospital, was also included in the present study. We analyzed the clinical and immunohistochemical characteristics from these case reports.
Results:
The analysis totally incorporates 21 case reports and our own case, covering 22 subjects. Among all cases we found 11 adenocarcinomas, 7 small-cell carcinomas, and 4 squamous carcinomas. In addition, most of metastatic breast masses were located below or near the nipple, rather than in the outer quadrant. The results of immunohistochemistry mostly showed triple negative breast cancers.
Conclusion:
A lung cancer patient with a breast tumor should suggest the possibility of metastasis. It is extremely difficult to distinguish secondary breast cancer from primary simply through medical observation and pathologic testing. Additional immunohistochemical examinations are necessary to avoid delays in diagnosis and treatment.
... Eur J Breast Health shadowing, and calcifications, which are commonly detected in primary breast cancers are very rare in secondary tumors (2,3,7,16). ...
... There were multiple lesions located superficially in the subcutaneous fatty tissue and additional lesions deep in the parenchyma. Tumors which disseminate via lymphatic route, tend to manifest as skin thickening, subcutaneous edema and trabecular thickening due to tumor emboli in the subcutaneous lymphatic channels (2). There may or may not be an apparent mass (9,17). ...
... Clinically peau d'orange and redness over the skin may be detected rarely. These cases can be falsely diagnosed as mastitis or inflammatory breast cancers (2,4). Ovarian, gastric and lung cancers have been reported to lead to this type of breast metastases (4,16,19,20). ...
... Metastasis from any primary cancer to breast comprise 0.5-6.6% of all breast malignancies 1 . Among them, the primary contralateral breast is dominant and other extra-mammary sites like lymphoma, melanoma, ovarian tumors, pulmonary neoplasm, gastrointestinal and genitourinary malignancy contribute to 1.2% to 2% [2][3][4] . Out of all extra-mammary diseases, melanoma comprises the major fraction of metastatic tumor to the breast and it may happen even years after excision 5 . ...
Secondary in the breast is a very rare condition but may occur usually from contralateral breast and from others like lymphoma, melanoma, ovarian tumors, and pulmonary malignancies and malignancies of the gastrointestinal and genitourinary tract. Among the primary diseases, melanoma is notorious and unpredictable in its metastatic potentiality and organ of dissemination. There are few reported cases with metastatic melanoma in the breast. We report a case of metastatic deposits in the breasts of a 45year-old lady who presented with bilateral breast lumps with axillary lymphadenopathy having no primary site of melanoma. Journal of Surgical Sciences (2015) Vol. 19 (2) : 72-74
