Metastasis to the breast from an adenocarcinoma of the lung with extensive micropapillary component: a case report and review of the literature

Nicoletta Maounis,Xanthi Tsiafaki,Aphrodite Emmanouilidou,Stella Legaki,Maria Chorti,Maria Demonakou,Eleni Ellina

doi:10.1186/1746-1596-5-82

Nicoletta Maounis, Xanthi Tsiafaki + Show 5 more

Open Access

https://doi.org/10.1186/1746-1596-5-82

Copy DOI

Abstract

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 component, diagnosed concomitantly with the primary tumor. A 73-year-old female presented with dyspnea and dry cough of 4 weeks duration and a massive pleural effusion was found on a chest radiograph. Additionally, on physical examination a poorly defined mass was noted in the upper outer quadrant of the left breast. The patient underwent bronchoscopy, excisional breast biopsy and medical thoracoscopy. By cytology, histology and immunohistochemistry primary lung adenocarcinoma with metastasis to the breast and parietal pleura was diagnosed. Both the primary and metastatic anatomic sites demonstrated histologically extensive micropapillary component, which is recently recognized as an important prognostic factor. The patient received chemotherapy but passed away within 7 months. Accurate differentiation of metastatic from primary carcinoma is of crucial importance because the treatment and prognosis differ significantly.

Highlights

The National Cancer Institute of the U.S.A. estimates, that based on current rates, 12.7% of women born today will be diagnosed with breast cancer in their life time [1]
We report a patient with metastasis to the breast from a pulmonary adenocarcinoma with extensive micropapillary pattern diagnosed concomitantly with the primary tumor
By immunocytochemistry performed on smears prepared from the pleural effusion sample, tumor cells were strongly immunoreactive for thyroid transcription factor-1 (TTF-1) (Figures 2c, d) and monoclonal CEA

Summary

Background

We report a patient with metastasis to the breast from a pulmonary adenocarcinoma with extensive micropapillary pattern diagnosed concomitantly with the primary tumor. By immunocytochemistry performed on smears prepared from the pleural effusion sample, tumor cells were strongly immunoreactive for thyroid transcription factor-1 (TTF-1) (Figures 2c, d) and monoclonal CEA. Our differential diagnosis included primary lung adenocarcinoma, metastatic adenocarcinoma from the thyroid, the breast or the ovary and metastatic epithelioid (papillary) type - mesothelioma. Based on the histology and the immunohistochemical staining pattern, a diagnosis of primary lung adenocarcinoma with micropapillary component was rendered. H&E stained paraffin sections of the parietal pleura biopsies revealed diffuse infiltration by malignant epithelioid type cells, which demonstrated solid and micropapillary pattern. The tumor cells demonstrated immunoreactivity for TTF-1 (Figure 5c, d), SP-A and lacked expression of GCDFP-15, ER and mammaglobin (Table 1)

Findings

Discussion

Conclusions