Case Of Metastatic Breast Carcinoma Research Articles

Discordance in receptor status between primary and metastatic breast cancer and overall survival: A single-center analysis

BackgroundThe tumor phenotype may change between primary and metastatic breast cancer. We compared the expression of estrogen receptor (ER), progesterone receptor (PR), and HER2 in a series of primary breast carcinomas (PBC) with their metastatic relapses and analyzed the impact of any changes on survival. Materials and methodsIt was a single-center retrospective study, collecting consecutive cases of metastatic breast carcinoma diagnosed in the pathology and medical oncology departments at Habib Bourguiba University Hospital in Sfax, Tunisia. An immunohistochemical study was used to assess ER, PR, and HER2 expression. Overall survival (OS) and post-metastasis survival (PMS) were evaluated using multivariable Cox regression analysis. ResultsOur study included 68 patients. ER and PR status changed in 29.4 % and 39.7 % of cases, respectively. Conversions were mainly from positive to negative status (22 % and 23.5 % for ER and PR, respectively). Differences in HER2 status were observed in 19.6 % of cases, with loss of overexpression in 6 patients (10.7 %). Adjuvant trastuzumab therapy and PBC molecular subtype (HR-, HER2+) were associated with HER2 status discordance (p = 0.02 and 0.03, respectively). On multivariable analysis, HR-negative conversion tumors were significantly associated with a worse OS (p = 0.042) and PMS (p < 0.001), compared to HR-concordant positive tumors. ConclusionThis study establishes that HR and HER2 status discordance between primary and metastatic breast carcinoma has a prognostic impact on patient outcome. Analyzing these receptors' status in all newly diagnosed cases of metastatic breast carcinoma is strongly recommended and would provide information for changing treatment strategies.

Agarose cell block and ancillary molecular tests enhance diagnostic efficacy of liquid-based cytology samples

Background The concomitant use of cytology smears and cell block (CB) preparations for ancillary techniques represents a useful diagnostic performance, especially in suspicious malignant cases or with equivocal cytological morphology. CBs prepared by the agarose-based technique have a high morphologic quality. Agarose prevents notable loss of diagnostic cells during CB preparation. This can be used as a maximal investment for the residual supernatant liquid-based cytology (LBC) material. Aim To study the use of agarose CBs from residual LBC material as a diagnostic tool added to cytology smears in fluid and fine-needle aspiration cytology. Patients and methods The current study included 65 cases utilizing LBC slides, and agarose CBs prepared from the residual LBC material. Ancillary studies were performed on CBs using immunomarkers: CK-7, CK-20, ER, PR, CEA, calretinin, pan-cytokeratin, Her2, CK5/6, P63, TTF-1, HMB-45, and S-100, as well as chromogenic in-situ hybridization (CISH) Her2. Results The majority of our studied agarose CBs (89.2%) had morphologic criteria of the diagnostically superior category. Immunohistochemistry on agarose CBs raised the sensitivity from 85.3 to 100% in effusion cytology and from 92.9 to 100% in aspiration cytology. In this study, 60 out of 65 studied cases needed further diagnostic verification with consequent use of ancillary techniques on agarose CBs including immunohistochemistry and CISH. Regarding effusion cytology samples, immunomarkers enabled subtyping of 21 cases of metastatic adenocarcinoma (14 cases of noncolorectal origin and seven cases of metastatic colorectal adenocarcinoma). Moreover, verification of the origin of malignant cells in effusion cytology samples could be reached (mesothelioma was proved in 4/6 cases and disproved in two cases that were reported as metastatic adenocarcinoma). Moreover, the inconclusive cases of effusion cytology could be solved; 9/14 cases were confirmed as benign and the remaining five cases were reported as metastatic adenocarcinoma. In our study, two cases of metastatic breast carcinoma in pleural effusion were requested for hormonal profile (one showed positivity to ER, PR, and Her2 by immunocytochemistry and the other was triple negative, and Her2 negativity was confirmed by CISH performed on the agarose CB). In pulmonary specimens, immunohistochemical subtyping of nonsmall cell carcinoma cases was possible (6/8 cases were confirmed as squamous cell carcinoma, and the remaining two cases were adenocarcinomas). In the studied five cases of lymph node aspirates, the provisional broad diagnosis of metastatic undifferentiated malignancy could be further specified by immunohistochemical application of certain tumor markers; their choice was suggested according to morphologic criteria of LBC material. Of these five cases, there was one case of metastatic malignant melanoma. Another two cases were highly suggestive of thyroid origin. Unfortunately, two of these metastatic undifferentiated cases had diagnostically unsuitable CBs, and no further studies could be done. Four lymph node aspirates were inconclusive for metastasis and were reclassified by immunohistochemistry as three cases of reactive lymphadenopathy and one case of metastasis. Accordingly, final cytologic diagnosis could be achieved in 63 (97%) of our total 65 studied cases. The complementary use of agarose CBs helped in diagnosis of 54 (96.4%) of 56 cases that needed ancillary tests. Conclusion Agarose CBs prepared from LBC residues, together with cytology smears, can achieve significant and accurate results when coupled with different ancillary studies.

Metastatic breast carcinoma to the urinary bladder-a report of 11 cases including a tumor to tumor metastasis.

Metastatic breast carcinoma to the urinary bladder is rare. Eleven cases of metastatic breast carcinoma to the bladder are described in this report, including one case with a tumor to tumor metastasis. The patients ranged from 51 to 83years of age. The time intervals between the diagnosis of primary breast cancer and the occurrence of bladder metastases ranged from 41 to 336months. There were seven cases of invasive ductal carcinoma and four cases of invasive lobular carcinoma. In one case, a lobular carcinoma of the breast metastasized to a concurrent squamous cell carcinoma of the bladder. The immunophenotypic status of estrogen receptor and Her2 expression of the metastatic carcinomas were all concordant with the primary tumors. In nine patients with follow-up available, seven patients died of the disease ranging from 1 to 23months after the diagnosis of the bladder metastasis and two patients were alive at 5months of follow-up. To date, this report is the largest single series of patients with breast carcinoma metastatic to the bladder. It is the first reported instance of lobular carcinoma of the breast metastasizing to a squamous cell carcinoma of the bladder.

Unilateral indurated plaque in the axilla: a case of metastatic breast carcinoma

Breast cancer is the most commonly diagnosed cancer among American women and is also the most common internal malignancy to metastasize to the skin. Rarely, cutaneous metastases represent the first indication of breast carcinoma, putting dermatologists in an instrumental position to make the diagnosis of breast carcinoma. We report the case of a 71-year-old woman with a 10-year history of a slowly-enlarging, indurated plaque in the right axilla. Review of symptoms was significant only for occasional numbness and tingling that extended from the right axilla to the right hand. Biopsy revealed cells infiltrating in a single-file between the collagen bundles in the dermis and subcutis and immunohistochemical staining consistent with a diagnosis of invasive lobular carcinoma. Subsequent work up revealed a primary breast lesion and extensive bony metastases.

Collision tumor of bone: primary chondrosarcoma of bone as a rare recipient of tumor-to-tumor metastasis from metastatic breast carcinoma

Collision tumors are the rare phenomenon of two histologically distinct tumors occurring in the same anatomic location. We report an unusual case of metastatic breast carcinoma colliding with primary grade 1 chondrosarcoma in the femur of a 58-year-old female.

375P - Breast Carcinoma with Distant Metastasis at Initial Presentation: Impact of Breast Surgery in Real-Life Clinical Practice

ABSTRACT Aim: About 5–10% of breast cancer (BC) patients (pts) are metastatic breast carcinoma (MBC) at diagnosis. Systemic therapy is the usual initial approach in this setting. Radical locoregional surgery is still controversial. The present study aims to assess the use and impact of breast surgery in MBC outcome in real-life clinical practice. Methods: Retrospective series of cases of MBC at diagnosis admitted in our Institution between 1995 and 2008. Medical records were reviewed with collection of demographic and clinical variables. Population characterization was performed using descriptive statistics. Survival analysis was assessed through Kaplan-Meier and log-rank test for subgroups comparison. Uni and multivariate analysis for prognostic variables was accomplished by Cox proportional hazard model Results: We identified 326 MBC pts at presentation (3% of all BC pts). Median age was 59 yr (range 20-91). Most pts (238 - 75%) had positive hormonal receptors (HR) and 130 (44%) were cT4. Visceral metastases were identified in 134 pts. Surgery was the first treatment in 79 pts (24%), while the majority (71%) were initially treated with systemic approach. Among pts treated initially with systemic therapy, 50% were submitted to surgery afterwards. Fifteen pts (5%) were proposed for best supportive care upfront. Median overall survival (OS) was 21 months, with 5-year survival of 20% (95% CI 17,6-24,4). Patients submitted to surgery present the best OS rates, either if performed as initial therapy (27vs20 months, p = 0,003) or after systemic therapy (38vs10 months, p Conclusions: The present review confirms the common use of breast surgery in real-life practice for MBC at diagnosis, with a favourable impact in outcome. Our data suggest that the best timing for breast surgery is after systemic treatment, supporting the importance of distant metastasis control before locorregional treatment Disclosure: All authors have declared no conflicts of interest.

Tumor-to-tumor metastasis (TTM) of breast carcinoma within a solitary renal angiomyolipoma: A case report

Angiomyolipomas of the kidney have been known to harbor malignant neoplasms including renal cell carcinoma. We report a case of a tumor-to-tumor metastasis (TTM) involving metastatic breast carcinoma and angiomyolipoma. The patient was a 67-year-old female with a history of invasive ductal carcinoma of the breast. Follow-up positron emission tomography 9 years later revealed a left renal mass, suspicious for a primary renal neoplasm, as well as a suspicious subpectoral lymph node. An ultrasound-guided needle biopsy of the lymph node demonstrated metastatic breast carcinoma. The patient underwent a left radical nephrectomy. Pathologic examination demonstrated an ill-defined 2cm estrogen receptor (ER)-positive metastatic breast carcinoma within a 6cm angiomyolipoma. To our knowledge, this is the first reported case of metastatic breast carcinoma to a solitary renal angiomyolipoma. This case highlights the importance of a patient's prior history of malignancy, as well as appropriate sampling of renal neoplasms.

Concurrence of Primary Hyperparathyroidism and Metastatic Breast Carcinoma Affected a Parathyroid Gland

Involvement of the parathyroid glands by metastatic tumor is rare. Breast is 1 of the primary sites in metastatic cancers. We introduce a rare case of metastatic breast carcinoma affecting a parathyroid gland, which was clinically combined with parathyroid gland hyperplasia. A 65-year-old woman was referred due to hypercalcemia and constipation. The patient had a history of left breast carcinoma. She was admitted to the hospital because of the recent discovery of hypercalcemia and elevation of PTH. A Tc99m-sestamibi scan showed retained uptake in the right thyroid and in the lower pole of the left thyroid gland. Aspiration biopsy results revealed that the nodule in the posterior portion of the right thyroid was metastatic breast cancer and the nodule in the left thyroid gland was the hyperplastic parathyroid gland. This case illustrates that hyperparathyroidism caused by parathyroid hyperplasia was concurrent with metastatic breast cancer to a parathyroid gland without disseminated systemic metastasis. Although this case is very uncommon and it is not clear whether there is a relationship between breast cancer and primary hyperparathyroidism, that possibility should always be considered as the cause of hypercalcemia in patients with breast cancer.

Cutaneous metastatic breast carcinoma with clear cell features

Breast carcinoma remains one of the most common sources of skin metastases in women. Cutaneous breast carcinoma metastases have variable clinical and histopathologic presentations that can make diagnosis challenging. We report a unique case of metastatic breast carcinoma with prominent clear cell features, thus mimicking a xanthomatous process. Dermatopathologists should be aware of this entity given its resemblance to other clear cell infiltrates and neoplasms.

A Rare Case of Metastatic Breast Carcinoma to the Stomach and the Colon

Purpose: A 46 year old female presented to the emergency department after a routine lab draw revealed pancytopenia with hemoglobin of 5.4. She was complaining of chronic fatigue, left upper quadrant pain, and a palpable lump beneath her left breast. She had also noted unintentional weight loss over the past several months. She had previously received several blood transfusions for persistent microcytic anemia though the cause of her anemia had not been established. Previous attempts at colonoscopy and mammography were unsuccessful due to her morbid obesity. Her past medical history included IDDM, myocardial infarction, stroke, and hepatitis C. On exam the patient was afebrile with a heart rate of 91 and blood pressure of 122/71. In general she was a pale, morbidly obese female in no distress. Breast exam revealed a palpable mass in the lower quadrant of the left breast. Abdominal exam was significant for splenomegaly. Stool guaiac was positive. Laboratory exam revealed a WBC of 3.9, Hgb 5.7, HCT 17, and PLT 38,000. She was admitted for work-up of her pancytopenia and abdominal pain. A peripheral smear revealed marked normochromic normocytic anemia and thrombocytopenia. A CT scan was done to evaluate her abdominal pain and revealed hepatosplenomegaly and a mottled appearance of her pelvis and spine. Colonoscopy revealed 2 sessile polyps which were removed by cold biopsy polypectomy. EGD was done and multiple small polypoid lesions were noted along with cobblestoning of the gastric mucosa. Multiple biopsies were taken and histologic findings and results of immunohistochemical stains were consistent with primary breast cancer with metastasis to stomach and colon. Discussion: The true incidence of breast cancer metastatic to the gastrointestinal tract is not clear. Most instances of breast cancer metastatic to the GI tract have been reported as case reports with gastric or intestinal involvement. The combined upper and lower GI tract involvement is rare. In general, gastrointestinal metastases are reported to occur in 4-18% of patients with known disseminated breast cancer.Figure: A: Stomach nodules-EGD. B: Stomach pathology. C: Colon pathology.

Metastatic breast carcinoma to parathyroid adenoma on fine needle cytology sample: Report of a case

Metastases to the thyroid gland diagnosed by means of fine needle cytology or by excision have been reported in the literature. To our knowledge, metastatic neoplasms to the parathyroid gland have never been described up to now. In this article, we introduce a rare case of metastatic breast carcinoma to a parathyroid adenoma in a 56-year-old woman, which clinically simulated a left thyroid nodule. The patient had a history of left breast carcinoma; the recent discovery of a palpable mass in the left thyroid area had elicited fine needle cytology sampling for its diagnostic evaluation. The obtained cytopathological sample was cellular but limited to a single Diff-Quik-stained smear; hence, no ancillary studies could be entertained. A cytopathological diagnosis of positive for malignant cells of query metastatic breast origin was performed. The permanent histopathological examination of the surgical sample disclosed multiple small foci of metastatic high-grade carcinoma of ductal type within a somewhat atypical adenoma of the parathyroid gland. The cytopathological findings and some differential diagnostic considerations are briefly commented, as well as the deranging imaging data concerning this interesting case.

Metastatic Breast Carcinoma Presenting with Profound Hypocalcemia

Hypocalcemia is a rare complication of malignancy. We present the case of a 30-year-old lady presenting with a grand mal seizure due to profound hypocalcemia. She was subsequently found to be hypoparathyroid and was diagnosed with metastatic breast carcinoma. Treatment with goserelin and exemestane produced a significant reduction in her tumor load and a correction of her hypocalcemia, which was initially refractory to treatment. We believe this to be the first case of metastatic breast carcinoma actually presenting with hypocalcemia and feel that clinicians should be aware of this rare complication.

Metastatic Breast Carcinoma Initially Diagnosed as Pulpal/Periapical Disease: A Case Report

IntroductionMetastatic tumors to oral cavity and jaws are rare, and mandible is the most commonly involved location. Because the most common jaw symptom is pain, these lesions could be misdiagnosed as pathologic entities with dental origin. In this article a case of metastatic breast carcinoma initially diagnosed as pulpal/periapical disease is presented and discussed. MethodsA 40-year-old female patient was referred to our department with vague pain in right mandibular area. Clinical and radiographic examinations were performed, leading to the initial diagnosis. Patient's medical history was reevaluated, and an incisional biopsy was performed to confirm the final diagnosis. ResultsRegarding the initial signs and symptoms, a pulpal/periapical inflammatory process was considered in the differential diagnosis. Because lip paresthesia was also noted, a more aggressive process was suspected. Patient's medical records and histopathologic slides were requested and reviewed carefully. The diagnosis of metastatic breast carcinoma was confirmed by comparing the histopathologic findings of the jaw lesion with previous slides of the breast. ConclusionsDespite their rarity, metastatic tumors should be considered in the differential diagnosis of inflammatory and reactive lesions of the jaws. These lesions might be diagnosed first by the patient's dentist or by the maxillofacial surgeon. This case emphasized the importance of a complete and careful work-up with particular attention to detailed medical history as well as careful clinical and radiographic inspection for unusual signs and symptoms.

甲状腺転移をきたした乳腺腺管癌例

甲状腺転移をきたした乳腺腺管癌例

Solitary breast cancer metastasis to the bladder: An unusual occurrence

Breast carcinoma is the most common nondermatologic cancer diagnosis in women. Common metastatic sites include lymph nodes, lung, liver, and bone. Metastases to the bladder are exceedingly rare. To date, there are a total of 31 reports of patients diagnosed with metastatic breast cancer to the bladder while living. Only 5 of these patients were reported to have no other site of metastasis, other than axillary nodes at breast surgery. We present the sixth reported case of metastatic breast carcinoma solely to the bladder in a living patient.

Breast carcinoma metastasizing to the urinary bladder presenting as bilateral hydronephrosis treated with ureteral stenting and chemotherapy

We describe a case of metastatic breast carcinoma involving the urinary bladder and causing bilateral hydronephrosis. Treatment consisted of bilateral renal decompression followed by chemoradiotherapy. The pertinent literature is reviewed.

Expression of WT1, CA 125, and GCDFP-15 as Useful Markers in the Differential Diagnosis of Primary Ovarian Carcinomas Versus Metastatic Breast Cancer to the Ovary

Metastatic breast carcinoma to the ovary is sometimes difficult to differentiate from primary ovarian carcinoma. This problem is often encountered in breast carcinoma patients who develop adnexal masses. ER and PR can be positive in a high percentage of breast and ovarian carcinomas, and therefore cannot be used in the differential diagnosis of these entities. WT1 and CA125 have been identified as possible markers for ovarian cancer. However, no studies have been done that specifically compare the immunophenotype of breast carcinoma metastatic to ovary with that of primary ovarian cancer. Thirty-nine cases of metastatic breast carcinoma to the ovary, 36 primary breast carcinomas, and 42 primary ovarian carcinomas were examined immunohistochemically for the expression of WT1, CA125, carcinoembryonic antigen, MUC2, MUC1, and GCDFP. The percentage of cells stained and the intensity of staining were recorded. Thirty-two ovarian carcinomas (76%) were positive for WT1, including 31 of 33 (94%) serous carcinomas. Most of them had strong and diffuse staining. None of the breast cancers either primary or metastatic to the ovary expressed WT1. Thirty-eight (90%) ovarian carcinomas were positive for CA125, most of them with strong and diffuse staining. Most breast carcinomas were negative for CA125, with only 6 (16%) of the primary ones and 5 (12%) of the metastatic showing weak and focal positivity. All ovarian carcinomas were negative for GCDFP. Five primary breast cancers (14%) and 17 (43%) metastatic to the ovary were positive for GCDFP. Nine (21%) ovarian carcinomas, 8 (22%) primary breast carcinomas, and 13 (33%) metastatic to the ovary were positive for carcinoembryonic antigen. Almost all tumors examined were positive for MUC1 (100% ovarian carcinomas, 100% primary breast carcinomas, and 95% metastatic breast carcinomas to ovary). MUC2 was positive in 10 (24%) ovarian carcinomas, 3 (8%) primary breast cancers, and 12 (30%) metastases to the ovary. The presence of immunoreactivity for WT1 and CA125 in a carcinoma involving ovary strongly favors a primary lesion. Most ovarian carcinomas are positive for both markers, whereas the majority of metastatic breast carcinomas to the ovary are negative. GCDFP can be complementary in this differential diagnosis.

Carcinoma of the Breast Metastatic to the Optic Nerve Mimicking an Optic Nerve Sheath Meningioma: Case Report and Review of the Literature

Isolated metastatic tumors to the optic nerve are extremely rare. We describe a rare and unusual case of metastatic breast carcinoma to the optic nerve that mimicked an optic nerve sheath meningioma in its presentation due to its indolent symptom progression, initial radiological appearance, and minimal growth on serial imaging. The patient, a 46-year-old woman with a history of stable metastatic breast carcinoma, presented with progressive visual loss in her right eye over a 6-month interval. Magnetic resonance imaging revealed an enhancing lesion in the optic canal with an extension to the right anterior clinoid process and planum sphenoidale and into the right orbital apex, consistent with the presumptive diagnosis of optic nerve sheath meningioma. The tumor was resected and pathologically confirmed to be metastatic carcinoma of the breast. The clinical course, radiological features, surgical approach, and treatment strategies are reviewed.

Rectal metastases from lobular carcinoma of the breast: Report of a case and literature review

Metastatic involvement of the gastrointestinal (GI) tract secondary to breast cancer is rare. Reported herein is the case of a 74-year-old woman with metastatic lobular breast carcinoma to the rectum presenting with obstruction. The breast tumour was diagnosed nine years prior to the presentation of rectal metastases. Endoscopy was repeated twice until a diagnosis was established. Examination of endoscopy material revealed infiltration of the rectum by malignant signet ring cells identical to those of the primary breast tumour. The patient did not respond to chemotherapy and underwent laparotomy with a defunctioning colostomy. Literature review revealed only a few more cases of metastatic breast carcinoma to the rectum. Awareness of this condition may lead to accurate diagnosis and early initiation of systemic treatment, thus avoiding surgical intervention.

Nuclear grooves in fine‐needle aspiration biopsies of breast lesions: Do they have any significance?

Nuclear grooving is a recognized morphologic feature frequently seen in papillary carcinoma of the thyroid. This feature is also occasionally seen in other nonneoplastic and neoplastic conditions. Nuclear grooves have been described in tubular carcinoma of the breast. However, the significance of nuclear grooves in benign and malignant conditions of the breast has been rarely studied. In a retrospective study, we searched for the presence of nuclear grooves in Papanicolaou-stained and Diff-Quik-stained fine-needle aspiration biopsies (FNAB) of 50 cases of primary breast carcinoma, 25 cases of proliferative breast disease, and 25 cases of fibroadenoma. In addition, 10 cases of metastatic breast carcinoma diagnosed by FNAB were reviewed. Nuclear grooves were identified in 39 of 50 (78%) of the histologically confirmed primary breast carcinomas and in 9 of 10 (90%) of the cases of metastatic breast carcinoma in the Papanicolaou-stained smears. Nineteen of 50 (38%) of the cases of proliferative breast disease/fibroadenoma showed nuclear grooves in the Papanicolaou-stained smears. The difference between the percentage of cases showing nuclear grooves seen in the Papanicolaou-stained primary breast carcinomas and metastatic breast carcinomas compared with the benign breast lesions was statistically significant (P < 0.001 in the primary breast carcinoma cases and P < 0.01 in the metastatic breast cancer cases). Nuclear grooves were identified less often in the Diff-Quik-stained smears, and their presence in malignant lesions versus cases diagnosed as benign breast disease was not statistically significant. This study suggests that, although the presence of nuclear grooves is more frequently seen in malignant breast lesions, their presence cannot totally exclude the possibility of benign breast disease. The presence of nuclear grooves, however, may serve as a diagnostic clue in metastatic tumors of unknown primary. Diagn. Cytopathol. 1998;18:333–337. © 1998 Wiley-Liss, Inc.