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Histologic findings of the left breast tumor after lumpectomy. (A) Gross findings of the specimen showed an irregular shaped whitish fibronodular lesion. (B) Hematoxylin and eosin (H&E)-stained paraffin sections of the lumpectomy specimen revealed extensive micropapillary components (H&E stain, ×40). (C) Microscopic findings of the specimen showed small clusters of cells within clear stromal spaces resembling dilated vascular channels with a desmoplastic reaction (H&E stain, ×400).
Source publication
Background
Breast metastasis from extramammary malignancy is uncommon and often presents diagnostic challenges. Herein, we report a case of a patient with metachronous isolated breast metastasis from pulmonary adenocarcinoma with micropapillary component.
Case presentation
A 47-year-old woman presented with left breast nodule detected on a screeni...
Contexts in source publication
Context 1
... primary breast cancer was suspected, and the patient underwent lumpectomy and sentinel lymph node biopsy using radio-isotope and indigocarmine dye. Gross examination of the specimen revealed an irregular shaped whitish fibronodular lesion, measuring 1.3 × 1 cm in size ( Figure 3A). The specimen was fixed in 10% formalin, and paraffin sections were prepared. ...
Context 2
... specimen was fixed in 10% formalin, and paraffin sections were prepared. Hematoxylin and eosin (H&E)-stained paraffin sections of the lumpectomy spe- cimen revealed extensive micropapillary components ( Figure 3B). Microscopic examination of the sections from the specimen showed small clusters of cells within clear stromal spaces resembling dilated vascular channels ( Figure 3C) with a desmoplastic reaction. ...
Context 3
... and eosin (H&E)-stained paraffin sections of the lumpectomy spe- cimen revealed extensive micropapillary components ( Figure 3B). Microscopic examination of the sections from the specimen showed small clusters of cells within clear stromal spaces resembling dilated vascular channels ( Figure 3C) with a desmoplastic reaction. There were no ductal components and carcinoma in situ lesions. ...
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Citations
... 6 Eighteen additional cases with detailed clinical information from 2013 to 2017 were identified in our literature search of the PubMed database (Table 1). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Of these 18 cases, four involved male patients and 14 female patients, with ages ranging from 40 to 74 years (average, 56.5 years). Among the cases, including one in which adenocarcinoma transformed into small cell carcinoma following tyrosine kinase inhibitor treatment, 11 were adenocarcinomas and two small cell lung carcinomas. ...
Key Clinical Message
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.
... Other sites have been reported as lung, rhabdomyosarcoma, renal adenocarcinoma, leiomyosarcoma, cervix, vulva, stomach, endometrial adenocarcinoma and plasma cell myeloma. [1][2][3][4][5][6][7][8][9][10] Clinical symptoms from the breast metastatic focus may be the first presentation of the disease. Differentiation of primary breast cancer from a metastatic auxiliary source is essential to decide on best management. ...
... Other less common sites are lung (13%), colon, rhabdomyosarcoma, renal adenocarcinoma, leiomyosarcoma, cervix, vulva, stomach, endometrial adenocarcinoma and plasma cell myeloma. [1][2][3][4][5][6][7][8][9][10]24,25 The secondary malignant lesions in the breast are most often freely mobile, well-circumscribed, round oval masses. There is also frequently an absence of skin involvement. ...
The metastasis of extra-mammary malignancy to breast is extremely rare; literature reports the incidence between 0.4-1.3%. Primary sites include the contralateral breast, leukaemia, lymphoma, malignant melanoma, sarcoma, lung, prostate, ovary, colon and the stomach. Here we present a rare case in which lung cancer was found to metastasise to the breast. Initially the patient presented with chest symptoms and a left breast lump was detected clinically. The radiological and histological investigations confirmed the diagnosis of primary lung cancer with breast metastases. Prognosis of such cases is generally poor.
... Extramammary non-hematological metastasis to the breast comprised 0.3-0.4% of malignant breast tumors [13][14][15][16][17][18][19][20]. On one hand, surgical resection of primary tumor of metastatic breast cancer is associated with favorable outcomes among selective patients in prospective randomized trials as well as in retrospective and population-based studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. ...
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.
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.
BRAF
mutations occur in about 3% of all lung adenocarcinomas and V600E missense mutation characterizes about half ofBRAF-mutated lung adenocarcinomas and is significantly associated with micropapillary pattern and shorter disease-free and overall survival rates. In this report, we report a challenging case of a patient with a metastatic micropapillary adenocarcinoma of the lung harbouring V600EBRAFmutation who experienced a surprising protracted clinical response to metronomic vinorelbine. The possible association between the V600EBRAFmutation pathway and the effective use of vinca alkaloid is discussed.
Background: It remains unclear whether surgical resection of in-breast metastasis from extramammary malignancies would improve survival. Methods: There were 29 cases including 25 cases reported by 24 studies and 4 unreported cases from PUMC Hospital in this individual patient data (IPD) meta-analysis. The clinicopathological characteristics and overall survival (OS) were compared. The subgroup of patients who might potentially benefit from surgical resection of the metastatic lesion to the breast was identified. Results: The breast symptoms were 22 lumps (75.9%), 4 huge mass (13.8%), 3 inflammatory changes (10.3%), 1 ulceration (3.4%) and 1 non-palpable lesion (3.4%). There were 2 male patients (6.9%) with breast metastasis and 3 female patients (10.3%) with bilateral breast metastasis. The primary malignancy sites included 10 gastrointestinal (34.5%), 7 lung (24.1%), 4 urogenital (13.8%) and 3 trunk and limbs (10.3%). Adenocarcinoma (48.3%) was the commonest pathology. Twelve patients (41.4%) had metastases only to the breast. Seven breast metastases (24.1%) were diagnosed simultaneously with the primary malignancies, and 2 breast metastases (6.9%) were detected before the primary. The 12-month OS rate was 55.2% and the median survival was 5 month (1-60 months). Sixteen patients (55.2%) received surgical resection of the in-breast metastases, and their OS was not significantly different from those biopsy-only patients. Conclusions: Surgical resection of metastases to the breast from extra-mammary malignancies could achieve similar survival outcome compared to patients who only received core needle biopsy, with potential of improving the quality of life for patients with breast ulceration, huge mass and inflammatory changes.
