Diagnosis Of Metastatic Breast Carcinoma Research Articles

Utility of Wnt family member 9b (Wnt9b) immunohistochemistry inthe cytologic diagnosis of metastatic breast carcinoma.

Wnt family member 9b (Wnt9b) has been demonstrated as a valuable marker for breast cancer diagnosis in surgical pathology. In this study, we examined the utility of Wnt9bin diagnosing metastatic breast carcinomaincytologysamples. Cell blocks from fine needle aspirations (FNA) and fluid specimens of 96 metastatic breast carcinomasand 123 primary and metastatic non-breast neoplasms from various organ systems were evaluated by Wnt9band GATA3 immunohistochemistry (IHC). Wnt9b and GATA3 were positive in 81.3%and 92.7%ofmetastaticbreast carcinomas, respectively. Conversely, 93.5%and 90.0%of non-breast, non-urothelial carcinomas were negative for Wnt9b and GATA3, respectively. Wnt9b expression was positive in rare gastrointestinal, gynecological, lung, pancreas, and salivary gland tumors. All twenty-eight urothelial carcinomas were negative for Wnt9b, while twenty-six (92.9%) were positive for GATA3. Wnt9b was slightly less sensitive but more specific than GATA3 in diagnosing metastatic breast cancer in cytology samples. Particularly, Wnt9b shows higher specificity in differentiating breast and urothelial primaries. The combined use of Wnt9b and GATA3 may increase diagnostic accuracy.

Deep Learning-Based Computational Cytopathologic Diagnosis of Metastatic Breast Carcinoma in Pleural Fluid.

A Pleural effusion cytology is vital for treating metastatic breast cancer; however, concerns have arisen regarding the low accuracy and inter-observer variability in cytologic diagnosis. Although artificial intelligence-based image analysis has shown promise in cytopathology research, its application in diagnosing breast cancer in pleural fluid remains unexplored. To overcome these limitations, we evaluate the diagnostic accuracy of an artificial intelligence-based model using a large collection of cytopathological slides, to detect the malignant pleural effusion cytology associated with breast cancer. This study includes a total of 569 cytological slides of malignant pleural effusion of metastatic breast cancer from various institutions. We extracted 34,221 augmented image patches from whole-slide images and trained and validated a deep convolutional neural network model (DCNN) (Inception-ResNet-V2) with the images. Using this model, we classified 845 randomly selected patches, which were reviewed by three pathologists to compare their accuracy. The DCNN model outperforms the pathologists by demonstrating higher accuracy, sensitivity, and specificity compared to the pathologists (81.1% vs. 68.7%, 95.0% vs. 72.5%, and 98.6% vs. 88.9%, respectively). The pathologists reviewed the discordant cases of DCNN. After re-examination, the average accuracy, sensitivity, and specificity of the pathologists improved to 87.9, 80.2, and 95.7%, respectively. This study shows that DCNN can accurately diagnose malignant pleural effusion cytology in breast cancer and has the potential to support pathologists.

Polyostotic feet acrometastases from breast carcinoma demonstrated on [18F]FDG PET/CT imaging.

Acrometastases are rare. Less than 0.01% of patients have metastasis in the foot bone. Polyostotic metastasis in the foot is extremely rare. We report a 50-year-old woman who complained of progressive pain and swelling in the right foot after radical right mastectomy for 4 years. [18F]FDG PET/CT demonstrated multiple mixed bone destruction in the right foot with intense [18F]FDG PET/CT uptake. CT-guided calcaneus biopsy confirmed the diagnosis of metastatic breast carcinoma.

Triple Negative Invasive Ductal Carcinoma of Breast with Oral Metastasis: A Case Report

Metastatic oral malignancies have been reported in the mandible, tongue, and gingiva. Breast cancer oral metastasis usually presents as a benign oral lesion clinically. At histology, it shares several features with metastatic carcinoma. Immunohistochemistry (IHC) can be useful in the differential diagnosis. The clinical presentation consisted of swelling in the upper front tooth region in a 35-year-old woman. The lesion was excised under local anaesthesia and underwent histological and immunohistochemical examination to rule out any malignancy. Histological findings, Pan CK positivity suggesting the epithelial origin and the absence of reactivity to Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER2) indicated metastatic triple negative breast carcinoma. The histological diagnosis of metastatic breast carcinoma can be confirmed by IHC. The current case report illustrates the necessity of including a panel of IHC markers in confirming the diagnosis of metastatic lesions in oral cavity. By utilising such panels, one can expedite the prognosis and prevent delay in diagnosis.

Occult breast cancer presenting as metastatic carcinoma in a right axillary lymph node of a post-menopausal female: A case report and review of literature

Introduction: Occult breast cancer (OBC) is a clinically recognizable metastatic carcinoma from an undetectable primary breast tumor. It is rare and accounts for 0.3–1% of all breast cancers, often presenting with lymph node, bone, or skin metastases. It poses a diagnostic challenge for general surgeons, radiologists, and pathologists. Case Report: We present the case of occult breast cancer in a 62-year-old, post-menopausal, female, Nigerian, presenting with a solitary, painless, right axillary lymph node enlargement without a clinical or radiological evidence of a breast mass; and also review the literature. The diagnosis of metastatic breast carcinoma was made and confirmed on histology and immunohistochemistry analysis of the axillary lymph node. Histological examination of the subsequent right breast mastectomy specimen revealed the presence of infiltrating ductal carcinoma even though no definite mass lesion was seen on gross examination. Conclusion: Occult breast cancer can be a diagnostic challenge and should be excluded in any patient presenting with solitary axillary lymphadenopathy. Immunohistochemistry staining patterns can be a mainstay in resolving the differential diagnoses.

Utility of TRPS-1 immunohistochemistry in diagnosis of metastatic breast carcinoma in cytology specimens

At present, GATA binding protein 3 (GATA-3) is the most frequently used diagnostic immunohistochemical (IHC) marker for breast carcinoma (BC). However, it is not specific and has very low sensitivity for triple-negative BC (TNBC). SRY-box transcription factor 10 (SOX-10) and trichorhinophalangeal syndrome type 1 (TRPS-1) have been suggested for inclusion in the diagnostic workup of TNBC. TRPS-1 has not been established in cytology specimens as a diagnostic IHC marker for metastatic BC (MBC). Hence, in the present study we evaluated the utility of TRPS-1 in diagnosing MBC in cytology specimens. MBC cases diagnosed on cytology specimens from January to October 2020 were included in the present study. Only cases with hormonal status available and ≥20 tumor cells on cell blocks were included in the study. The cell blocks were assessed for TRPS-1, GATA-3, and SOX-10 IHC marker positivity (intensity and percentage of tumor cells). The results were correlated with the specimen type (fine needle aspiration [FNA] versus body fluid) and various BC prognostic subgroups. We analyzed 61 cases, including 33 body fluid and 28 FNA (13 lymph node, 10 bone, 2 liver, 2 soft tissue, and 1 lung) specimens. TRPS-1 had 97.2% positivity in ER/PR+ (estrogen receptor/progesterone receptor-positive) MBC compared with GATA-3, which had 100% positivity in the same group. TRPS-1 showed high positivity in 35 of 37 cases (94.6%) and intermediate positivity in 1 (2.6%) and was negative/low positive in 1 case (2.7%). In contrast, GATA-3 showed high positivity for all 37 cases (100%). SOX-10 showed positivity in only 1 of 37 cases (2.7%), with intermediate positivity. In the HER2+ (human epidermal growth factor receptor 2-positive) group, TRPS-1 showed high positivity in 5 of 7 cases (71.4%), intermediate positivity in 1 case (14.3%), and negativity in 1 case (14.3%). However, GATA-3 showed high positivity in 6 of 7 cases (85.7%) and negative/low positivity in 1 case (14.3%). SOX-10 was negative in all 7 cases. In TNBC, TRPS-1 showed high positivity in 16 of 17 cases (94%) and intermediate positivity in 1(5.9%), and GATA-3 showed high positivity in 9 (53%), intermediate positivity in 2 (11.8%), and low positive/negative in 6 of the 17 cases (35.3%). TRPS-1 expression was significantly higher than GATA-3 expression for the number of positive cases (P = 0.07), mean percentage of positive tumor cells (P=0.005), and intensity of reactivity (P = 0.005). SOX-10 expression was present in only 5 of 17 cases (29%), with a mean percentage of positivity in the tumor cells of 26.5% and intensity of 0.8. No differences were found in the IHC results between the different specimen types (FNA versus fluid) in any group. TRPS-1 is a highly sensitive new diagnostic IHC marker for breast carcinoma, with a similar positivity rate in ER/PR+ and HER2+ BC compared with GATA-3 and a higher positivity rate than GATA-3 and SOX-10 in TNBC in cytology specimens. In particular, when only a few clusters of tumor cells are present on the cell block, TRPS-1 can be highly useful, because its mean percentage of positive tumor cells and intensity are higher than those of other IHC markers.

METASTATIC NEOPLASM IN INSERTED GINGIVA AFTER ANTINEOPLASTIC SURGICAL TREATMENT OF BREAST CARCINOMA: A CASE REPORT

A 66-year-old female patient presented with an oral lesion with a 6-month evolution that she associated with a poorly adapted prosthesis. Medical history revealed systemic arterial hypertension and surgical oncological treatment (mastectomy 1½ years ago). Intraoral examination showed the presence of a sessile, fibrous, and erythematous nodule containing an ulcerated area and measuring 5 cm located in inserted gingiva of the lower left alveolar ridge. Superficial erosion represented by a noncorticated radiolucent area was also observed. Histological features of incisional biopsy samples showed malignant neoplasm of epithelial origin composed of cells with clear or eosinophilic cytoplasm, presenting pleomorphism, with rare tubular structures and vascular invasion, supported by scarce stroma. Immunohistochemical analysis revealed intense and diffuse positivity for GATA3 and estrogen and progesterone receptors and negativity for CK7, CK20, P40, and BREAST-1. Microscopic features were consistent with the diagnosis of metastatic breast carcinoma. The patient was referred for oncologic treatment.

Differences in GATA3 expression among histological/molecular subtypes and grades in infiltrating breast carcinoma (IBC) are important in the diagnosis of metastatic breast carcinoma.

GATA-binding protein 3 (GATA3) is a sensitive and relatively specific marker in invasive breast carcinomas (IBC). The aim of the present study was to determine GATA3 expression among different histological and surrogate molecular breast carcinoma subtypes. Immunohistochemical staining of ER, PR, Ki67, HER2 and GATA3 was performed in a cohort of 84 consecutive cases of primary IBCs. The association of GATA3 expression with different histological subtypes, grades and surrogate intrinsic molecular subtypes was assessed. The overall positivity of GATA3 across various histological subtypes was 71.43% with no correlation with histological type (p = 0.849). Our study also confirmed that GATA3 exhibits a relatively high sensitivity for IBC (78.57%). GATA3 expression was positively correlated with low histological grades (G1/G2) vs. G3: p = 0.001) with most of G3 (57.89%) cases being negative and with luminal A (72.22%) and B (84.62%) subtypes (p = 0.00001) while most of the triple negative (87.5%) and HER2-overexpressed (66.67%) being negative. Caution must be payed however when dealing with an IBC metastasis of HER2-overexpressed or triple negative molecular subtypes or G3, since in these categories according to the present study, GATA3 is more frequently negative that previously reported and may be useless for diagnosis of tumor origin.

Effects of Hydrochloric Acid and Formic Acid Decalcification on Breast Tumor Biomarkers and HER2 Fluorescence In Situ Hybridization.

Biomarker analysis of metastatic breast carcinoma (MBC) is routinely recommended by ASCO/CAP guidelines, and establishing a diagnosis of MBC often requires immunohistochemistry (IHC). The reliability of breast tumor biomarkers and breast-specific markers on decalcified tissues has not been extensively studied. We performed IHC studies on breast tumors exposed to hydrochloric acid (HCl) and formic acid (FA) decalcification solutions, and HER2 fluorescence in situ hybridization on a subset of these tumors to establish a protocol for handling bone specimens with suspicion for MBC. Fifteen fresh cases of primary breast carcinoma and 8 HER2+ paraffin-embedded core biopsy cases were studied. Fresh tissue was divided into 5 fragments to approximate a bone core biopsy. One fragment (control) was fixed in 10% neutral buffered formalin. The remaining fragments were also exposed to FA or HCl decalcification for 1 or 5 hours. All fragments were embedded in 1 block and tested with an IHC panel. The known HER2+ cases were exposed to either 1 or 5 hours of FA, and HER2 fluorescence in situ hybridization was also performed. Results were interpreted as follows: H-scores for estrogen receptor, progesterone receptor, and GATA-3 were assigned from 0 to 300; HER2, cytokeratin 7, gross cystic disease fluid protein-15, Pax-8, TTF-1, cytokeratin 20, and mammaglobin were scored from 0 to 3+; and Ki67 from 0% to 100%. Mean scores were compared using the t test or Wilcoxon test for paired samples. No significant differences in mean score were seen between NF and 1 hour FA for any IHC immunoreactivity. After 5 hours of FA, only Ki67 average score was significantly less than NF. Mean scores for estrogen receptor, progesterone receptor, HER2, Ki67, and GATA-3 were significantly lower than NF in the tissue after either 1 or 5 hours of HCl. Mean scores for gross cystic disease fluid protein-15, mammaglobin, and cytokeratin 7 staining were not significantly lower than NF after 1 or 5 hours of HCl.

Integrated landscape of copy number variation and RNA expression associated with nodal metastasis in invasive ductal breast carcinoma.

BackgroundLymph node metastasis (NM) in breast cancer is a clinical predictor of patient outcomes, but how its genetic underpinnings contribute to aggressive phenotypes is unclear. Our objective was to create the first landscape analysis of CNV-associated NM in ductal breast cancer. To assess the role of copy number variations (CNVs) in NM, we compared CNVs and/or associated mRNA expression in primary tumors of patients with NM to those without metastasis.ResultsWe found CNV loss in chromosomes 1, 3, 9, 18, and 19 and gains in chromosomes 5, 8, 12, 14, 16-17, and 20 that were associated with NM and replicated in both databases. In primary tumors, per-gene CNVs associated with NM were ten times more frequent than mRNA expression; however, there were few CNV-driven changes in mRNA expression that differed by nodal status. Overlapping regions of CNV changes and mRNA expression were evident for the CTAGE5 gene. In 8q12, 11q13-14, 20q1, and 17q14-24 regions, there were gene-specific gains in CNV-driven mRNA expression associated with NM.MethodsData on CNV and mRNA expression from the TCGA and the METABRIC consortium of breast ductal carcinoma were utilized to identify CNV-based features associated with NM. Within each dataset, associations were compared across omic platforms to identify CNV-driven variations in gene expression. Only replications across both datasets were considered as determinants of NM.ConclusionsGains in CTAGE5, NDUFC2, EIF4EBP1, and PSCA genes and their expression may aid in early diagnosis of metastatic breast carcinoma and have potential as therapeutic targets.

Breast Cancer as a Cause of Intestinal Obstruction? A Case Report

Annually, approximately 230?000 women and 2300 men are diagnosed with breast cancer. It is the second most common malignancy occurring in women in the United States. The most common type of breast cancer is ductal carcinoma while invasive lobular carcinoma (ILC) being the second (1). The most common sites of breast cancer metastasis are located in the liver, lung, brain and bones. Out of 12001 cases of primary breast cancer, Matsuda et al, reported 73 cases of GI spread, of which only 24 cases presented as colorectal metastatic disease. (2) Within the GI tract, the stomach and the small bowel are the most common metastatic sites of lobular carcinoma, whereas large intestine infiltration is rare. We report the case of a 67 years old female with history of infiltrating lobular carcinoma of the breast with bone and recent discovered brain metastasis that presented to the emergency room with abdominal pain. She complained of a two-week history of epigastric abdominal pain worsened by oral intake. There was associated nausea and vomiting of food content. She had been constipated lately, and her last bowel movement was four days before admission. A CT abdomen showed a wall thickening in the cecum and nearby ascending colon. A colonoscopy showed an ulcerated partially obstructing cecal mass. Surgery was consulted for removal of the mass; a Lap right hemicolectomy and end ileostomy was done with the removal of a 5 cm mass. It was positive for CK7, GATA3 and ER; but negative for CDX2 and CK20, supporting the diagnosis of metastatic breast carcinoma. It was positive for cytoplasmic p120 staining, consistent with a lobular phenotype. After surgery the patient was discharged with scheduled follow-ups<./p> As previously mentioned, the GI involvement of a breast tumor is very rare. Less than 1% of GI metastatic disease was noted in 2500 cases of primary breast cancer over an 18-year follow-up period. (3) It is more common to discover a second primary GI cancer in patients with prior history of breast cancer (4). This case shows the importance of understanding the clinical progression of this growing subtype of breast cancer. A high index of suspicion for possible GI metastatic disease in patients with a history of ILC, whether newly diagnosed or in remission, is needed. This patient presented with constipation due to obstruction but diarrhea can be our only symptom that should prompt a rapid investigation as ILC typically mimics macroscopic changes seen in IBD.1663 Figure 1. Cecal wall thickening corresponding to a mass formation.

Gata3 Immunohistochemical Staining is A Useful Marker for Metastatic Breast Carcinoma in Fine Needle Aspiration Specimens.

Aims:The utility of GATA3 immunohistochemistry (IHC) as an aid to the cytological diagnosis of metastatic breast carcinoma in fine needle aspiration (FNA) specimens was investigated.Materials and Methods:Cell block sections from 111 FNA cases of metastatic malignancy were stained for GATA3, including metastases from 43 breast and 44 nonmammary adenocarcinomas, 19 melanomas, 4 urothelial carcinomas, and 1 thyroid medullary carcinoma. Sites sampled included lymph nodes (87), bone (8), liver (5), lung (6), superficial masses (4), and pelvic mass (1).Results:Ninety-one percent (39/43) of metastatic breast carcinoma cases were positive for GATA3. All estrogen receptor (ER)-positive were also GATA3 positive cases. The majority (9/14; 64%) of ER-negative and 37% (3/8) of triple-negative cases were positive for GATA3. All nonmammary adenocarcinoma cases were negative with the exception of one case of metastatic pancreatic adenocarcinoma. Metastatic melanoma cases were all negative but 75% (3/4) urothelial carcinomas expressed GATA3.Conclusions:GATA3 IHC staining is a useful addition to IHC panels for FNA samples in specific settings such as distinguishing metastatic breast from lung carcinoma or melanoma.

Utility and pitfalls of GATA3 immunocytochemistry for diagnosis of metastatic breast carcinoma and urothelial carcinoma on cytology specimens

Although GATA3 expression has been studied extensively on histology specimens and has demonstrated a high level of accuracy in detecting carcinomas from breast or urothelial origin, its utility on cytology samples, especially the influence of different sample (fine-needle aspiration [FNA] versus effusion fluid) and preparation (cell block versus smear) on the staining, is understudied. We retrospectively searched our institution's pathology database for cytologic cases where GATA3 immunostaining was performed during diagnostic workup and identified a total of 178 cases, consisting of 89 metastatic breast carcinomas, 22 metastatic urothelial carcinomas, and 67 malignant neoplasms of other origin. Frequency of GATA3 expression was evaluated in each group. For metastatic breast carcinomas, 75% expressed GATA3; 74% on FNA samples and 77% on fluid samples; 71% on cell block and 89% on smear. GATA3 was positive in 44% triple-negative breast carcinomas. Of the 22 metastatic urothelial carcinomas (21 FNA samples and 1 fluid; 21 cell blocks and 1 smear), all were positive for GATA3. Of the 67 malignancies of other origin, 4 (6%) were positive for GATA3 (ie, a metastatic ovarian serous carcinoma, a metastatic squamous cell carcinoma, a recurrent poorly differentiated skin adnexal carcinoma, and a metastatic thymic carcinoma). GATA3 is a useful biomarker for detecting carcinomas of breast or urothelial origin on cytologic specimens. It may detect breast cancers with the triple-negative phenotype. Both cell block and smear preparations can be reliably used for the staining. GATA3-positive immunostaining is occasionally seen in other tumors, which may cause diagnostic confusion.

Immunohistochemical distinction of primary sweat gland carcinoma and metastatic breast carcinoma: can it always be accomplished reliably?

Even with adequate history, the distinction of cutaneous metastatic breast carcinoma from primary sweat gland carcinoma can be difficult. Although previous studies have attempted to separate these tumors with various immunohistochemical panels, those series have been limited by small numbers of patients as well as the inclusion of benign sweat gland tumors. In this analysis, stains for p63, CK5/6, and D2-40 were included, as well as GATA3 and mammaglobin, in an evaluation of 21 primary sweat gland carcinomas and 33 examples of cutaneous metastatic breast carcinoma. Immunoreactivity for p63, CK5/6, D2-40, GATA3, and mammaglobin was respectively observed in 81%, 71%, 52%, 71%, and 5% of sweat gland carcinomas compared with 6%, 6%, 6%, 91%, and 45% of metastatic breast carcinomas. These differences were statistically significant for p63, CK5/6, and D2-40. For the diagnosis of metastatic breast carcinoma, GATA3 was the most sensitive marker (91%), but its sensitivity was substantially lower. Mammaglobin was 95% specific for breast carcinoma but again suffered from limited sensitivity (45%) in this context. These data suggest that p63 and CK5/6 are specific determinants for sweat gland carcinoma in the stated setting. In the absence of those analytes, metastatic breast carcinoma cannot always be identified to the exclusion of a primary tumor. This diagnostic scenario continues to require the procurement of a detailed clinical history regarding the number and duration of skin lesions in any given case.

Utility of GATA3 immunohistochemistry for diagnosis of metastatic breast carcinoma in cytology specimens.

GATA3 as a diagnostic marker of metastatic breast carcinoma in cytology specimens has not been fully established. Metastatic breast carcinoma was assessed for GATA3, mammaglobin, and GCDFP-15 immunohistochemistry on cell blocks. GATA3 was scored by intensity (0, negative; 1, weakly positive; 2, moderately positive; 3, strongly positive), and area (0-100%). Mammaglobin (MMG) and GCDFP-15 staining was scored qualitatively (positive vs. negative). Results were correlated with specimen type (fine-needle aspiration vs. body fluid), breast prognostic markers estrogen receptor (ER), progesterone receptor (PR), Her-2/Neu (Her2), and Ki67, and with each other. Statistical significance was determined by chi-squared test and ANOVA for numerical variables. Alpha was set as 0.05. A total of 40 CB specimens containing metastatic breast carcinoma were studied. GATA3 was positive in 32 (80%) cases. All ER-positive cases (n = 25) were positive for GATA3. Conversely, all GATA3-negative cases (n = 8) were triple-negative breast cancers. On qualitative univariate analysis, GATA3 was statistically associated with ER (P = 0.0001), and PR (P = 0.0468). GATA3 intensity was statistically associated with ER (P ≤ 0.0001), PR (P = 0.0157), Her2 (P = 0.0256), and cancer category (P = 0.0127). GATA3 staining was statistically associated with ER (P ≤ 0.0001), PR (P = 0.0160), Her2 (P = 0.0451), and cancer category (P = 0.0002). MMG and GCDFP-15 were directly compared to GATA3 in 35 samples. The sensitivity was 86% for GATA3, 26% for MMG, and 14% for GCDFP-15. GATA3 is a more sensitive diagnostic marker of metastatic breast carcinoma in CB samples than MMG and GCDFP-15.

Touch preparations for the intraoperative evaluation of sentinel lymph nodes after neoadjuvant therapy have high false-negative rates in patients with breast cancer.

The use of a touch preparation for intraoperative sentinel lymph node diagnosis has become a preferred method of many pathologists because of its reported high sensitivity and rapid turnaround time. However, after neoadjuvant chemotherapy many lymph nodes have significant treatment-related changes that may affect the diagnostic accuracy of the intraoperative evaluation. To determine the accuracy of touch preparation for the intraoperative diagnosis of metastatic breast carcinoma in the neoadjuvant setting. We reviewed retrospectively the results of intraoperative evaluations for 148 different sentinel lymph nodes from 63 patients who had undergone neoadjuvant chemotherapy for invasive breast cancer at our institution. The intraoperative touch preparation results were compared with the final pathology reports in conjunction with relevant clinical data. Use of touch preparation for the evaluation of sentinel lymph nodes intraoperatively after neoadjuvant therapy was associated with a low sensitivity of 38.6% (95% confidence interval [CI], 24.4-54.5) but high specificity of 100% (95% CI, 96.5-100). There was no difference in sensitivity rates between cytopathologists and noncytopathologists in this cohort (P = .40). Patients with invasive lobular carcinoma and those who had a clinically positive axilla before the initiation of neoadjuvant therapy were the most likely to have a false-negative result at surgery. Intraoperative touch preparations should not be used alone for the evaluation of sentinel lymph nodes in the setting of neoadjuvant therapy for breast cancer because of low overall sensitivity.

What can the pathologist offer for optimal treatment choice?

The choice of the most appropriate systemic treatment of patients with metastatic breast carcinoma is a multifaceted decision-making process. The role for the pathologist is to provide a definite diagnosis of metastatic breast carcinoma, whenever needed, and especially to assess the biological parameters with prognostic and predictive value. Although the vast majority of breast carcinomas maintain the same biological features both in the primary and in the metastases, some undergo changes that may indicate that a targeted systemic treatment should be stopped or started, be it endocrine or anti-HER2. Unfortunately these tumours cannot be easily identified clinically, and it may be useful to biopsy the metastatic sites for reassessment of the biological characteristic of the tumours. Intra-tumoural heterogeneity and clonal selection due to the therapy could explain changes in biological features during tumour progression, but it should also be taken into account that the available assays for evaluating hormone receptor and HER2 status are not 100% accurate, even in the hands of expert pathologists. To minimize the risk of inducing inappropriate changes in systemic treatments due to false-positive or false-negative results, the pathologists should make all efforts to improve accuracy and reproducibility of the assay procedures.

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.

２２年の経過を経て側頭骨転移が明らかになった乳癌例

Carcinoma rarely metastasizes to the temporal bone. We report breast carcinoma metastatic to the temporal bone. A 69-year-old woman treated for breast carcinoma 22 years earlier and seen for left otalgia was found in computed tomography (CT) and magnetic resonance imaging (MRI) to have an abnormal left temporal bone lesion. Biopsy under local anesthesia yielded a histopathological diagnosis of metastatic breast carcinoma. She has been treated with aromatase inhibitor and bisphosphonate, and the metastatic lesion has not grown.

Caecal metastasis from breast cancer presenting as intestinal obstruction

BackgroundGastrointestinal metastsasis from the breast cancer are rare. We report a patient who presented with intestinal obstruction due to solitary caecal metastasis from infiltrating ductal carcinoma of breast. We also review the available literature briefly.Case presentationA 72 year old lady with past history of breast cancer presented with intestinal obstruction due to a caecal mass. She underwent an emergency right hemicolectomy. The histological examination of the right hemicolectomy specimen revealed an adenocarcinoma in caecum staining positive for Cytokeratin 7 and Carcinoembryonic antigen and negative for Cytokeratin 20, CDX2 and Estrogen receptor. Eight out of 11 mesenteric nodes showed tumour deposits. A histological diagnosis of metastatic breast carcinoma was given.ConclusionTo the best of our knowledge, this is the first case report of solitary metastasis to caecum from infiltrating ductal carcinoma of breast. Awareness of this possibility will aid in appropriate management of such patients.