Abstract
IntroductionPatients undergoing complete treatments of breast carcinoma can be found with pulmonary nodules during the follow up period. Either metastasis from breast carcinoma or second primary bronchogenic carcinoma should be considered as a possible diagnosis.Case presentationsTwo female patients with ages of 66 and 64, underwent modified radical mastectomy for breast carcinoma 5 and 2 years ago, were found with single pulmonary nodule, 1.0 cm and 0.8 cm from the left lower and right upper lobe. There was no other site of metastasis being noted after systemic survey.Wedge resections through video assisted thoracic surgery were performed and one of them underwent lobectomy and mediastinal lymph node dissection after the primary lung carcinoma being proved pathologically (thyroid transcription factor 1 and cytokeratin 7 positive). The dissected lymph node in this patient is negative for malignancy. They underwent low dose chemotherapy postoperatively because of increased risk of tumor occurrence for these patients. Patients with smoking or irradiation history usually favor the diagnosis of second primary lung carcinoma. However, these two treated breast carcinoma cases, which didn’t have smoking or irradiation history, developed second primary lung carcinomas. It is relatively rare reported before.ConclusionsPulmonary nodules in patients with prior breast carcinomas were usually regarded as metastatic lesions. However, the possibility of second primary still cannot be excluded, especially to the solitary type. Video assisted thoracic surgery can provide early and accurate diagnosis as well as effective treatment.
Highlights
Patients undergoing complete treatments of breast carcinoma can be found with pulmonary nodules during the follow up period
Pulmonary nodules in patients with prior breast carcinomas were usually regarded as metastatic lesions
Breast irradiation will increase the risk of second primary lung carcinoma, and a multiplicative effect was observed in smokers
Summary
Pulmonary nodules that appear in a patient with prior malignancy may be a metastasis or a second primary lung cancer [1]. The estrogen and progesterone receptors are negative, and Her2/neu shows over-expression (2+) on the resected specimen She underwent postoperative adjuvant chemotherapy with 6 courses of intravenous epirubicin and fluorouracil, oral UFUR control for 24 months and Nolvadex for 5 years. The pathological report revealed a TTF1 and CK7 positive primary lung adenocarcinoma She underwent left lower lobectomy and mediastinal lymph nodes dissection. The estrogen and progesterone receptors are negative, and Her2/neu shows over- expression (3+) on the resected specimen She underwent oral chemotherapy with UFUR and hormone therapy with Nolvadex postoperatively. Chest CT revealed a 0.8cm nodule with smooth margin over the right upper lobe of lung (Figure 3) She underwent VATS wide excision under the impression of pulmonary metastasis from breast carcinoma (Figure 4). She was stable on the 4 months of follow up period
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