Extramammary Malignancies Research Articles

Unusual metastases to the breast from different extramammary malignancies: a multimodality imaging approach in a case series.

Extramammary metastases are uncommon and usually related to a poor prognosis, but the radiologist can suspect the diagnosis based on the patient's clinical history and specific imaging findings. Several imaging procedures may be used to evaluate breast metastases from different extramammary malignancies, including mammography, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-CT (PET-CT). The clinical and imaging presentation of these metastases is contingent upon how the illness spreads, however, they have the potential to resemble either benign or malignant breast tumors. Metastases that disseminate hematologically tend to appear as a single round or oval mass with circumscribed margins. Sonographically, they are usually hypoechoic, and with CT or MRI, they usually enhance. Lymphatic dissemination, for example, frequently reveals significant asymmetry with skin thickening and diffuse breast edema, which is compatible with an inflammatory breast carcinoma. Knowing the many types of cancers that have the potential to spread to the breast as well as being able to accurately diagnose them is crucial to prevent a needless mastectomy and provide guidance for subsequent treatment. The purpose of this article is to provide a better understanding of the imaging features and immunohistochemistry (IHC) of secondary tumors of the breast by presenting eight distinctive cases, which will enable radiologists to recognize this entity.

Intramammary Metastases from Extramammary Malignancies: An Update

Intramammary Metastases from Extramammary Malignancies: An Update

Clinical characteristics and survival of second primary breast carcinoma with extramammary malignancies.

To investigate the characteristics, diagnosis, survival and prognosis of second primary breast carcinoma (SPBC). Records of 123 patients with SPBC in Tianjin Medical University Cancer Institute & Hospital between December 2002 and December 2020 were retrospectively reviewed. Clinical characteristics, imaging features and survival were analyzed and comparisons between SPBC and breast metastases (BM) were made. Of 67156 newly diagnosed breast cancer patients, 123 patients (0.18%) suffered previous extramammary primary malignancies. Of the 123 patients with SPBC, approximately 98.37%(121/123)were female. The median age was 55 years old (27-87). The average diameter of breast mass was 2.7 cm (0.5-10.7). Approximately 77.24% (95/123) of the patients presented with symptoms. The most common types of extramammary primary malignancies were thyroid, gynecological cancers, lung, and colorectal. Patients with the first primary malignant tumor of lung cancer were more likely to develop synchronous SPBC, and those with the first primary malignant tumor of ovarian cancer were more likely to develop metachronous SPBC. When comparing with BM, patients with SPBC were more often older (≥45 years old), at earlier stages (I/II), more microcalcification and less multiple breast masses in imaging. More than half (55.88%) of patients in the metachronous group developed primary breast cancer within 5 years after diagnosis of extramammary primary cancer. The median overall survival time was 71 months. Within 90 months, the prognosis of patients with synchronous SPBC was worse than that of patients with metachronous SPBC (p=0.014). Patients with BM had the worst outcome compared with patients with synchronous SPBC and metachronous SPBC (p<0.001).ER/PR-negative status, an interval of less than 6 months between the onset of two tumors, a late stage of first primary malignancy, and an age of diagnosis of first primary malignancy greater than 60 years predicted a worse prognosis for patients with SPBC. The possibility of SPBC should be considered during the follow-up of patients with primary extramammary malignancy, especially within 5 years of the onset of the first tumor. The stage of first primary malignancy and the age at diagnosis of first primary malignancy have an impact on the prognosis of patients with SPBC.

Metastatic breast tumors from extramammary malignancies: a case series

BackgroundMetastatic breast tumors from extramammary malignancies are quite rare. Characteristics of such tumors are unclear due to small number of reported cases. During 2012–2019, approximately 3,500 malignant breast tumors were diagnosed with needle biopsy at our hospital and we experienced three cases (0.09%) of metastatic extramammary malignancies. We herein report these cases focused on imaging and pathological findings.Case presentationThe first case was a 59-year-old woman who underwent curative surgery for thyroid cancer. After developing lung and ovarian metastases, she visited our department with a mass in her right breast. Ultrasound revealed a 7 mm-sized oval mass. With high depth–width ratio and abundant blood flow, primary breast cancer was suspected. Core needle biopsy revealed atypical cells with nuclear grooves proliferating in papillary formation. With immunohistochemical examination, her final diagnosis was metastatic thyroid cancer. The second case was a 74-year-old woman with metastatic spinal tumors and referred to our department for searching primary tumor. She was diagnosed with gastric cancer at the age of 41. Ultrasound revealed a hypoechoic area including cysts and the internal echo level was uneven. Contrast-enhanced magnetic resonance imaging showed a non-mass lesion with heterogeneous internal enhancement pattern, suggesting ductal carcinoma in situ. Core needle biopsy showed alveolar lesion with predominant signet cell-like morphology. We histologically diagnosed her disease as metastatic gastric cancer. The last case was 33-year woman with Stage IV clear cell sarcoma of the left foot. She came to our department after she felt a lump on her right breast. Ultrasound revealed a 45 mm-sized mass. Her disease was confirmed as metastatic clear cell sarcoma by needle biopsy.ConclusionsImaging suggested malignancies, but it was difficult to distinguish them from primary breast cancer. Our cases indicate that metastatic tumors to the breast might have imaging patterns specific to primary organs, although more cases should be accumulated to establish such patterns on imaging. The first two cases shared some similar pathological findings with breast cancer, but also had some histological characteristics of the primary tumors. Hence, it was possible to diagnose these cases as metastatic tumors with careful observation.

Breast metastasis from an olfactory esthesioneuroblastoma: A case report and review of the literature

Metastases to the breast from an extra-mammary malignancy are extremely rare. Lymphomas and melanomas are the most commonly reported secondary tumors in the breast. Breast metastasis from an esthesioneuroblastoma is extremely rare and only 3 cases are described in the literature. We herein report another case of 31 year-old woman diagnosed with an esthesioneuroblastoma since two years, who presented to our hospital for a breast rapidly growing mass in the right upper inner quadrant. On physical examination, this mass measured 3cm, was firm with no skin retraction and no nipple discharge. Imaging features revealed multiples nodules with irregular border. A fine needed biopsy was performed. On pathological examination, the tumor was arranged in nests and lobules of monotonous tumor cells with round nuclei, indistinct nucleoli and scanty cytoplasm. On immunohistochemistry, the tumor cells were positive for chromogranin. Estrogen and progesterone receptors were negative as well as mammaglobin. Based on the pathological features and clinical history in conjunction with the immunohistochemical finding, the diagnosis of a metastasis of the esthesioneuroblastoma to the breast was made.Our case highlighted the importance of clinical history and imaging features when dealing with a breast lump.

Histological clues to the diagnosis of metastasis to the breast from extramammary malignancies.

The aims of this study were to review the histological features useful for the identification of metastases to the breast and to investigate the impression that this diagnosis has become more common. The histological features of metastases to the breast from 2008 to 2018 were reviewed. Seventy-four biopsies from 66patients were identified: 1% compared with primary carcinoma of the breast. Non-haematological metastases comprised 0.75% compared with 0.3% in a series from 1996 to 2005. The most common tumour types were pulmonary carcinoma (22), lymphoma (15), melanoma (13), gastrointestinal carcinoma (eight) and serous papillary carcinoma (four). In 73% there were histological features that were not typical of primary mammary carcinoma. Some metastases were histologically similar to breast cancer and the history was essential to making the correct diagnosis. Useful histological clues included small-cell morphology for pulmonary carcinoma, glands containing necrosis for gastrointestinal carcinoma, intranuclear inclusions, marked pleomorphism and spindle cells for melanoma, clear cells for renal carcinoma, papillary architecture for serous papillary carcinoma and sheets of centroblasts or nodules of centroblasts and centrocytes for lymphoma. Useful immunohistochemical markers included TTF-1 for pulmonary carcinoma, S100, melan-A and HMB45 for melanoma, CK20 and CDX2 for colorectal carcinoma, PAX8 and WT1 for serous papillary carcinoma and lymphoid markers for lymphomas, in addition to the absence of expression of mammary markers ER, GATA3 and GCDFP-15. The majority of metastases to the breast have histological clues to the diagnosis. Immunohistochemistry is helpful. This diagnosis is being made more frequently.

Multimodality Imaging Findings of Breast Metastases from Malignant Melanoma: A Case Series

Breast metastases stemming from extramammary malignancies are rare, occurring in approximately 1.3–2.7% of breast malignancies. The most prevalent are metastases belonging to the primary carcinoma of the contralateral breast, followed by lymphoma and malignant melanoma. Breast metastasis is to be suspected in patients with previous history of malignant melanoma who present with a breast mass. Distinguishing metastasis from primary breast neoplasms is a challenging task. Accurate diagnosis is crucial because the prognosis and management differ significantly between primary and secondary malignancies of the breast. Imaging features are non-specific on mammography and ultrasound. There have been several reports on the magnetic resonance imaging (MRI) characteristics of breast metastasis originating from malignant melanoma; however, only few studies have described the diffusion weighted imaging (DWI) feature and the apparent diffusion coefficient (ADC) value. In this study, we report the multimodality imaging features of three cases of breast metastases from malignant melanoma. We particularly focus on MRI findings, such as DWI feature and ADC value and compare them with the MRI features reported in the literature.

Breast cancer metastasis from Gastric Carcinoma in a young female

Gastric cancer is a disease of elderly patients and mainly metastasis to liver, lung, and peritoneum, while signet ring cell is a variant of gastric cancer and commonly metastasis to peritoneum and lymph nodes. Metastasis to mammary is a rare condition which account for 3% and has poor prognosis. Generally extra mammary carcinoma precedes breast metastasis by 2 years. It’s uncommon to have breast metastasis as a first manifestation of extra mammary malignancies. There is no age limit and presentation my mimic primary breast cancer. Due to rarity of this condition there are no consensuses about clinical, radiological and histological features which make it a challenging task to distinguish primary from metastatic breast neoplasm. The case bellow is a young woman with diagnoses of diffuse-signet ring cell gastric cancer. First presentation was right breast edema with ascites, peritoneal nodules, and enlarged enhancing ovaries on imaging. Biopsy from each site confirmed involvement by metastatic adenocarcinoma with signet ring pattern. Her condition progressed after 5th cycle of EOX.

Breast metastasis from a pulmonary adenocarcinoma: Case report and review of the literature.

[This retracts the article DOI: 10.3892/ol.2012.995.].

A case series of metastases to the breast from extramammary malignancies.

Metastases to the breast from extra-mammary malignancies are extremely uncommon. The discovery of a breast mass in a patient with a known primary tumor elsewhere poses a diagnostic challenge to the clinician. An awareness of the various malignancies that can metastasize to the breast and accurate diagnosis of the same is essential to avoid an unnecessary mastectomy and to guide further therapy. In this case series, we describe such clinical scenarios with an emphasis on the imaging features of metastases to the breast, which will enable radiologists to recognize this entity with greater ease.

A report of a rare case of breast metastasis from cutaneous malignant melanoma

Benign and primary malignant breast tumors are rather common, but secondary tumors in the breast from extramammary malignancies are uncommon. Breast metastases from melanoma are rare but could reflect a widespread disease. We present a case of melanoma of the right lateral chest wall with metastasis to the right breast and subcutaneous tissue in a postmenopausal female. She was planned for palliative chemotherapy with cisplatin and dacarbazine. Interim imaging after three cycles of chemotherapy showed stable disease. The long-term prognosis of patients with breast metastasis from malignant melanoma is extremely unfavorable.

Primary Small Cell Carcinoma Of Lung With Metachronous Breast Metastasis

Abstract Breast metastases from an extra-mammary malignancy are rare. Among the lung malignancies that metastasise in the breasts, previous literature has described approximately 30 cases of NSCLC and only a few cases of SCLC. Here, we present a 54-year-old woman with metachronous breast metastasis from pulmonary small cell carcinoma. She presented with a soft tissue mass in the right lung hilum. After bronchoscopy with biopsy, SCLC was verified. Th e patient was given 4 cycles of etoposide and cisplatin followed by radiation therapy. Seven months after the diagnosis of primary lung cancer, the patient palpated a mass in her right breast. Clinical examination and further diagnostics revealed the suspected malignancy, and a radical mastectomy was performed. Immunohistochemical findings suggested metastatic SCLC in the breast. Differentiation between primary and metastatic cancer in the breast is very important for therapeutic planning

Survival outcomes of surgical resection of metastasis to the breast from extra-mammary malignancies: an individual patient data analysis

Background: It remains unclear whether surgical resection of in-breast metastasis from extramammary malignancies would improve survival. Methods: There were 29 cases including 25 cases reported by 24 studies and 4 unreported cases from PUMC Hospital in this individual patient data (IPD) meta-analysis. The clinicopathological characteristics and overall survival (OS) were compared. The subgroup of patients who might potentially benefit from surgical resection of the metastatic lesion to the breast was identified. Results: The breast symptoms were 22 lumps (75.9%), 4 huge mass (13.8%), 3 inflammatory changes (10.3%), 1 ulceration (3.4%) and 1 non-palpable lesion (3.4%). There were 2 male patients (6.9%) with breast metastasis and 3 female patients (10.3%) with bilateral breast metastasis. The primary malignancy sites included 10 gastrointestinal (34.5%), 7 lung (24.1%), 4 urogenital (13.8%) and 3 trunk and limbs (10.3%). Adenocarcinoma (48.3%) was the commonest pathology. Twelve patients (41.4%) had metastases only to the breast. Seven breast metastases (24.1%) were diagnosed simultaneously with the primary malignancies, and 2 breast metastases (6.9%) were detected before the primary. The 12-month OS rate was 55.2% and the median survival was 5 month (1–60 months). Sixteen patients (55.2%) received surgical resection of the in-breast metastases, and their OS was not significantly different from those biopsy-only patients. Conclusions: Surgical resection of metastases to the breast from extra-mammary malignancies could achieve similar survival outcome compared to patients who only received core needle biopsy, with potential of improving the quality of life for patients with breast ulceration, huge mass and inflammatory changes.

Survival outcomes of surgical resection of metastasis to the breast from extra-mammary malignancies: an individual patient data analysis

Background: It remains unclear whether surgical resection of in-breast metastasis from extramammary malignancies would improve survival.

Breast metastases from extramammary malignancies: multimodality imaging aspects.

Breast metastases from extramammary cancers are rare and usually related to poor prognosis. The extramammary tumours most frequently exhibiting breast metastases are melanoma, lymphomas, ovarian cancer, lung and neuroendocrine tumours, and sarcomas. Owing to the lack of reliable and specific clinical or radiological signs for the diagnosis of breast metastases, a combination of techniques is needed to differentiate these lesions from primary breast carcinoma or even benign breast lesions. Multiple imaging methods may be used to evaluate these patients, including mammography, ultrasound, MRI, CT and positron emission tomography CT. Clinical and imaging manifestations are varied, depend on the form of dissemination of the disease and may mimic primary benign and malignant breast lesions. Haematologically disseminated metastases often develop as a circumscribed mass, whereas lymphatic dissemination often presents as diffuse breast oedema and skin thickening. Unlike primary carcinomas, breast metastases generally do not have spiculated margins, skin or nipple retraction. Microlobulated or indistinct margins may be present in some cases. Although calcifications are not frequently present in metastatic lesions, they occur more commonly in patients with ovarian cancer. Although rare, secondary malignant neoplasms should be considered in the differential diagnosis of breast lesions, in the appropriate clinical setting. Knowledge of the most common imaging features can help to provide the correct diagnosis and adequate therapeutic planning.

Survival Outcomes of Surgical Resection of Metastasis to the Breast from Extra-Mammary Malignancies: An Individual Patient Data Analysis

Background: It remains unclear whether surgical resection of in-breast metastasis from extra mammary malignancies would improve survival. Methods: There were 29 cases including 25 cases reported by 24 studies and 4 unreported cases from PUMC Hospital in this individual patient data (IPD) meta-analysis. The clinic pathological characteristics and overall survival (OS) were compared. The subgroup of patients who might potentially benefit from surgical resection of the metastatic lesion to the breast was identified. Results: The breast symptoms were 22 lumps (75.9%), 4 huge mass (13.8%), 3 inflammatory changes (10.3%), 1 ulceration (3.4%) and 1 non-palpable lesion (3.4%). There were 2 male patients (6.9%) with breast metastasis and 3 female patients (10.3%) with bilateral breast metastasis. The primary malignancy sites included 10 gastrointestinal (34.5%), 7 lung (24.1%), 4 urogenital (13.8%) and 3 trunk and limbs (10.3%). Adenocarcinoma (48.3%) was the commonest pathology. Twelve patients (41.4%) had metastases only to the breast. Seven breast metastases (24.1%) were diagnosed simultaneously with the primary malignancies, and 2 breast metastases (6.9%) were detected before the primary. The 12-month OS rate was 55.2% and the median survival was 5 month (1-60 months). 16 patients (55.2%) received surgical resection of the in-breast metastases, and their OS was not significantly different from those biopsy-only patients. Conclusion: Surgical resection of metastases to the breast from extra-mammary malignancies could achieve similar survival outcome compared to patients who only received core needle biopsy, with potential of improving the quality of life for patients with breast ulceration, huge mass and inflammatory changes.

Breast metastasis from rectal adenocarcinoma: a case report with US and CT findings

Metastasis to the breast from extramammary malignancies is unusual. We describe a case of rectal adenocarcinoma metastatic to the breast. A 21 year old woman had undergone abdominoperineal and vaginal resection and hysterectomy, right inguinal lymph node dissection for presenting vaginal bleeding ten months before. The patient was readmitted to our hospital for presenting edema and masses with severe pain in her breasts. US and contrasted CT was taken but mammography could not be performed due to severe tender and pain of her breasts. Breast US revealed diffuse skin thickening and bilateral multiple well-defined hypoechoic masses whereas contrasted CT delineated multiple, oval or round, and inhomogeneous superficial and invasive deep solid masses in her breasts with strong peripheral and moderate patchy central contrast enhancement and bilateral axillary lymph nodes. Breast biopsy and immunohistochemistry revealed rectal adenocarcinoma metastasis to the breast. To our knowledge, colorectal adenocarcinoma metastasis to the breast in women is extremely rare as 17 patients in the literature. Moreover, this is the fifth patient with bilateral breast metastasis from colorectal adenocarcinoma. This report also shows that CT is helpful to define axillary metastasis, the fixation and invasion of the deep metastatic lesions to the chest wall, which is unique feature of this metastatic tumor. CT could be used for early stage breast metastasis to some extent, but CT was diagnostic in late stage.

A Rare Case of Metastatic Primary Peritoneal Adenocarcinoma presenting as Breast Cancer

Metastasis to the breast as a presenting feature of extra mammary malignancy is extremely uncommon. Often in this setting, the distinction between primary and secondary breast malignancy can be challenging. Ovarian or primary peritoneal metastasis to the breast is suggestive of disseminated disease and associated with a guarded prognosis, thus accurate differentiation is crucial for early and appropriate intervention. We report the case of a patient presenting with what initially appeared to be locally advanced breast cancer but subsequent review of pathology and imaging confirmed the presence of metastatic primary peritoneal cancer.

A Rare Case of Metastatic Primary Peritoneal Adenocarcinoma Presenting as Breast Cancer

Metastasis to the breast as a presenting feature of extramammary malignancy is extremely uncommon. Often in this setting, the distinction between primary and secondary breast malignancy can be challenging. Ovarian or primary peritoneal metastasis to the breast is suggestive of disseminated disease and associated with a guarded prognosis, thus accurate differentiation is crucial for early and appropriate intervention. We report the case of a patient presenting with what initially appeared to be locally advanced breast cancer but subsequent review of pathology and imaging confirmed the presence of metastatic primary peritoneal cancer.

Young investigator challenge: The utility of GATA3 immunohistochemistry in the evaluation of metastatic breast carcinomas in malignant effusions.

It is not uncommon to encounter challenges in the immunohistochemical confirmation of metastatic breast cancer given the limited sensitivities of mammaglobin and gross cystic disease fluid protein 15 (GCDFP-15/BRST-2) and the significant proportion of triple-negative breast carcinomas (ie, tumors that are negative for estrogen receptor [ER], and progesterone receptor [PgR], and human epidermal growth factor 2 [HER2]). GATA binding protein 3 (GATA3) has emerged as a potentially useful immunohistochemical adjunct during the evaluation of metastatic breast carcinomas in cytology specimens. The objective of the current study was to examine GATA3 expression in the context of malignant effusions secondary to both mammary and extramammary malignancies. In total, 306 malignant effusions (from 62 metastatic breast carcinomas and 244 extramammary malignancies) were examined using GATA3 immunohistochemistry. Effusions with metastatic breast carcinoma were also examined using immunohistochemistry for additional breast markers (ER, PgR, HER2, mammaglobin, and GCDFP-15/BRST-2). GATA3 immunohistochemistry highlighted the tumor cells in 58 of the 62 samples (93.5%) from patients with metastatic breast carcinoma, which was higher than the observed sensitivity of immunohistochemistry for ER (63.8%), PgR (41.4%), HER2 (15.5%), mammaglobin (22.4%), and GCDFP-15/BRST-2 (5.2%). GATA3 expression also was observed in a subset of malignant effusions secondary to extramammary primaries, specifically, in 28 of 244 specimens (11.5%). GATA3 is a highly sensitive marker for the detection of metastatic breast carcinomas in effusion specimens. However, this marker is not entirely specific for malignancies of breast origin. Thus, GATA3 should be used in conjunction with additional immunohistochemical markers during the cytologic evaluation of malignant effusions.