Abstract
BackgroundMetastatic pulmonary tumors secondary to breast cancer detected either before or after surgery are predominantly multiple and bilateral. However, in cases detected to have a solitary pulmonary nodule (SPN), determining whether the lesion represents a primary cancer, metastasis, or a benign pulmonary lesion can be difficult.Materials and methodsBetween January 2000 and December 2009, we performed breast cancer surgery on 1,226 patients, of which 49 cases (3.9%) were detected to have pulmonary lesions before or after the surgery. In 14 of these patients, video-assisted thoracoscopic surgery was performed to remove a SPN.ResultPathological examination of the resected specimens in these 14 cases revealed metastatic pulmonary tumor in 8 cases, primary lung cancer in 3 cases, and benign disease in 3 cases. While lobectomy was performed in one of these patients with metastatic pulmonary tumor, the remaining 7 underwent partial resection of the lung. The primary lung cancer was an adenocarcinoma in all 3 patients, and lobectomy plus mediastinal lymph node dissection was performed in these patients. The tumor grading based on pathological diagnosis was T1N0M0, p-Stage 1A in all 3 patients. The prognosis was good in the breast cancer patients in whom the metastatic lung tumor was a SPN.ConclusionEvaluating the immunohistochemical cytokeratin profile and levels of the TTF-1 and GCDFP-15 of the lesion was useful when distinguishing between pulmonary cancer and metastatic pulmonary tumor. In addition, some patients exhibited changes in the biological properties of the metastatic tumor, and delete tumor resection by video-assisted thoracoscopic surgery can be useful for deciding the drug treatment strategy in some cases
Highlights
Metastatic pulmonary tumors secondary to breast cancer detected either before or after surgery are predominantly multiple and bilateral
The primary lung cancer was an adenocarcinoma in all 3 patients, and lobectomy plus mediastinal lymph node dissection was performed in these patients
Local therapy of metastases resulting in radical cure is extremely rare, and systemic pharmacotherapy is usually selected as the basic therapeutic approach, with the aim of prolonging life, alleviating symptoms, and improving the quality of life (QOL) in breast cancer patients with metastatic tumors
Summary
Metastatic pulmonary tumors secondary to breast cancer detected either before or after surgery are predominantly multiple and bilateral. In cases detected to have a solitary pulmonary nodule (SPN), determining whether the lesion represents a primary cancer, metastasis, or a benign pulmonary lesion can be difficult. Metastasis from breast cancer predominantly involves the bones, lungs, and liver. Local therapy of metastases resulting in radical cure is extremely rare, and systemic pharmacotherapy is usually selected as the basic therapeutic approach, with the aim of prolonging life, alleviating symptoms, and improving the quality of life (QOL) in breast cancer patients with metastatic tumors. Patients with metastatic pulmonary lesions often have multiple lesions and/or pleural effusion. Definitive diagnosis is achieved by imaging modalities, and pharmacotherapy is administered. In the case of a solitary pulmonary nodule (SPN), distinguishing between primary lung
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