Metastatic Breast Cancer Presenting Research Articles

A case of metastatic male breast cancer presenting as a factitial ulcer

A case of metastatic male breast cancer presenting as a factitial ulcer

Metastatic Breast Cancer Presenting as Patchy Colitis

Metastatic Breast Cancer Presenting as Patchy Colitis

The prognostic significance of computerised tomography findings in women with liver metastases from breast cancer

Aims While computerised tomography (CT) is used for diagnosis and assessing response to treatment little work has been performed on the prognostic significance of the CT findings in women with liver metastases. The aim of this study was to assess if the CT findings in women diagnosed with liver metastases at the time of first presentation with metastatic breast cancer have any prognostic significance. Materials and methods The staging CT scans of 78 consecutive women diagnosed with liver metastases at the time of first presentation of metastatic breast cancer were reviewed independently by two radiologists who were blinded to survival and the histological features of the tumour. The number and enhancement characteristics of liver metastases, whether metastases were solitary, multiple or diffuse, the diameter of the largest and the sum of the diameter of the five largest lesions, an estimate of % involvement (<10%, 10–50%, >50%), and the presence of metastases at other sites were assessed. HER-2 and ER status and histological grade of the patient’s primary breast cancer were also recorded. Survival was ascertained from hospital records. The prognostic significance of these factors was assessed in a univariate and multivariate fashion. Results At univariate analysis, number of liver metastases, sum of the diameter of the five largest lesions, percentage estimated involvement, presence of ascites, chest metastases and HER-2 status were significantly associated with reduced survival. Liver metastasis pattern (i.e. whether discrete or multiple), enhancement characteristics, ER status and histological grade were not associated with a significant outcome. At multivariate analysis estimated percentage liver involvement and the presence of chest metastases retained prognostic significance. Estimated percentage involvement was reproducible with 90% concordance between the two observers. Conclusions The CT appearances of patients with liver metastases at first presentation with metastatic breast cancer provide prognostic information which may be clinically useful.

Case report and literature review: Metastatic lobular carcinoma of the breast an unusual presentation

IntroductionInvasive lobular carcinoma is the second most common type of invasive breast carcinoma (between 5% and 15%). The incidence of invasive lobular carcinoma has been increasing while the incidence of invasive duct carcinoma has not changed in the last two decades. This increase is postulated to be secondary to an increased use of combined replacement hormonal therapy. Patients with invasive lobular carcinoma tend to be slightly older than those with non-lobular invasive carcinoma with a reported mean age of 57 years compared to 64 years. On mammography, architectural distortion is more common and microcalcifications less common with invasive lobular carcinoma than invasive ductal carcinoma. The incidence of extrahepatic gastrointestinal (GI) tract metastases observed in autopsy studies varies in the literature from 6% to 18% with the most commonly affected organ being the stomach, followed by colon and rectum. Gastric lesions seem to be slightly more frequent, compared to colorectal lesions (6–18% compared to 8–12%, respectively). Presentation of caseWe present the case of a 70-year-old woman who was referred to our institution with a concurrent gastric and rectal cancer that on further evaluation was diagnosed as metastatic invasive lobular carcinoma of the breast. She has a stage IV clinical T3N1M1 left breast invasive lobular carcinoma (ER positive at 250, PR negative, HER-2/neu 1+ negative) with biopsy proven metastases to left axillary lymph nodes, gastric mucosa, peritoneum, rectal mass, and bone who presented with a partial large bowel obstruction. She is currently being treated with weekly intravenous paclitaxel, bevacizumab that was added after her third cycle, and she is also receiving monthly zoledronic acid. She is currently undergoing her 12-month of treatment and is tolerating it well.Discussion Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women aged 20–59 years. It accounts for 26% of all newly diagnosed cancers in females and is responsible for 15% of the cancer-related deaths in women.9 Breast cancer is one of the most common malignancies that metastasize to the GI tract, along with melanoma, ovarian and bladder cancer. ConclusionWe present one of the first reports of metastatic lobular breast cancer presenting as a synchronous rectal and gastric tumors. Metastatic lobular carcinoma of the breast is a rare entity with a wide range of clinical presentations. A high level of suspicion, repetition of endoscopic procedures, and a detailed pathological analysis is necessary for early diagnosis, which might help to avoid surgical treatment due to incorrect diagnosis. Patients with a history of breast cancer who present with new gastrointestinal lesions should have these lesions evaluated for evidence of metastasis through histopathologic evaluation and immunohistochemical analysis. Differentiating between a primary GI lesion and metastatic breast cancer will allow initiation of appropriate treatment and help prevent unnecessary operations.

Painless Posterior Thigh Mass as a Presentation of Metastatic Breast Cancer

Soft tissue is usually not the site of distant dissemination of solid tumors. It has been shown that intramuscular soft tissue metastatic nodules are painful, whereas soft tissue sarcomas scarcely produce pain, but grow slowly.(1) Therefore, painless soft tissue nodules, especially remote from the index tumor are usually regarded as being unrelated to the primary carcinoma. Commonly, some solid tumors, such as lung, kidney, and colon carcinomas, have been known to be a prevalent source of soft tissue metastasis.(2) To date, there have been no reports on metastatic breast cancer presenting as a painless soft tissue nodule residing subcutaneously at the posterior thigh, and found to have multiple mediastinal lymph node metastases verified by positron emission tomography-computed tomography (PET-CT). As a result of an intense database search and to our understanding, this is the first report of its kind in Korea. We think it is very crucial to differentiate soft tissue metastasis from the index tumor and de novo soft tissue sarcoma given that the prognosis of each case may vary profoundly, especially after misdiagnosis. The onset of metastases into mediastinal lymph nodes and farther down to the posterior thigh seemed to be fairly rapid in this case, stressing the importance of a thorough followup in younger breast cancer patients who harbor a triplenegative phenotype.

Colorectal breast carcinoma metastasis diagnosed as an obstructive colonic primary tumor. A case report and review of the literature

Common sites of colorectal breast carcinoma metastasis are bones, lungs, the central nervous system and the liver. Metastases in the gastrointestinal (GI) tract are rare and especially involve the stomach rather than the colon. Clinical or radiological features usually cannot differentiate them from a primary colorectal tumor, resulting in inappropriate treatment. In some cases, this lesion suggests multifocal spread of breast cancer with peritoneal carcinomatosis. Colorectal breast cancer metastasis is a rare finding and there is no consensus on the management of these lesions. The present case report describes a 69-year-old female with metastatic breast cancer presenting as an obstructive tumor of the transverse colon.

Metastatic Breast Cancer Presenting as Cancer of Unknown Primary Associated with Superior Vena Cava Syndrome

The Breast JournalVolume 15, Issue 2 p. 202-203 Metastatic Breast Cancer Presenting as Cancer of Unknown Primary Associated with Superior Vena Cava Syndrome Hyun-Jeong Shim MD, PhD, Hyun-Jeong Shim MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorSe-Ryeon Lee MD, PhD, Se-Ryeon Lee MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorJae-Sok Ahn MD, PhD, Jae-Sok Ahn MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this author Duk-Hwan Yang MD, PhD, Duk-Hwan Yang MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorYeo-Kyeoung Kim MD, PhD, Yeo-Kyeoung Kim MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorSang-Hee Cho MD, PhD, Sang-Hee Cho MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorJe-Jung Lee MD, PhD, Je-Jung Lee MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorHyeoung-Joon Kim MD, PhD, Hyeoung-Joon Kim MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this author Ik-Joo Chung MD, PhD, Ik-Joo Chung MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this author Hyun-Jeong Shim MD, PhD, Hyun-Jeong Shim MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorSe-Ryeon Lee MD, PhD, Se-Ryeon Lee MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorJae-Sok Ahn MD, PhD, Jae-Sok Ahn MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this author Duk-Hwan Yang MD, PhD, Duk-Hwan Yang MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorYeo-Kyeoung Kim MD, PhD, Yeo-Kyeoung Kim MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorSang-Hee Cho MD, PhD, Sang-Hee Cho MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorJe-Jung Lee MD, PhD, Je-Jung Lee MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this authorHyeoung-Joon Kim MD, PhD, Hyeoung-Joon Kim MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this author Ik-Joo Chung MD, PhD, Ik-Joo Chung MD, PhD Department of Hemato-Oncology, Chonnam National University Medical School, Gwangju, KoreaSearch for more papers by this author First published: 09 March 2009 https://doi.org/10.1111/j.1524-4741.2009.00698.xCitations: 1 Address correspondence and reprint requests to: Sang-Hee Cho, MD, PhD, Department of Internal Medicine, Chonnam National University Hwasun Hospital, 160, Ilsimri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Korea, or e-mail: shcho@chonnam.ac.kr. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume15, Issue2March/April 2009Pages 202-203 RelatedInformation

Metastatic Breast Cancer Presenting as Air-space Consolidation on Chest Computed Tomography

A 56-year-old woman suffered from hepatic and bone metastases of breast cancer. Two months after starting combination chemotherapy with trastuzumab and docetaxel, air-space consolidation was observed in the right lower lung lobe on a chest computed tomography (CT) and a high serum KL-6 level was detected. Drug-induced pneumonitis with organizing pneumonia type was suspected, however, a transbronchial lung biopsy and cytological examination of the bronchoalveolar lavage fluid provided evidence of metastatic breast cancer. While the lung is a frequently affected site from metastasis of breast cancer, we report a rare case presenting as air-space consolidation on a chest CT.

Response of Cutaneous Metastases from Breast Cancer to Capecitabine

Excluding malignant melanoma, breast cancer has the highest incidence of cutaneous metastasis compared to any other solid malignancy. Up to 24% of patients with metastatic breast cancer are expected to have metastasis to the skin. Clinical trials testing various chemotherapeutic regiments for metastatic breast cancer generally do not report the success or failure rates of their regiments in relation to patients with metastasis to the skin. We report here 2 patients with cutaneous metastatic breast cancer who experiences dramatic and durable responses to single agent oral capecitabine. In addition we provide a brief review of the literature regarding the presentation, prognosis and treatment of cutaneous metastatic breast cancer with particular attention to local treatment modalities available.

Metastatic Breast Cancer Mimicking Small Bowel Crohnʼs Disease

Introduction: Small bowel involvement of metastatic breast cancer is a rare but recognized entity. It can present in a number of ways and can often be confused with primary disorders of the gastrointestinal (GI) tract such as Crohn's disease. We present a case of metastatic breast cancer to the terminal ileum initially presenting as abdominal pain. Case: A 62 year old Caucasian female with metastatic breast cancer to bone presented with left lower quadrant pain for 6 months. The pain was dull without radiation and no aggravating or relieving factors. She complained of no other GI related symptoms such as constipation, diarrhea, nausea, vomiting, weight loss or blood in stool. There was no known family history of colon cancer or inflammatory bowel disease. Initial workup included a CT scan which showed nonspecific wall thickening of the terminal ileum. A small bowel follow through was subsequently done and revealed mucosal effacement and nodularity of the last 15 cm of the terminal ileum. A colonoscopy to the terminal ileum was then done. Endoscopically, the terminal ileum appeared grossly abnormal with several ulcerations and surrounding erythema and edema. The colonic mucosa appeared normal except for scattered diverticulosis. Biopsies of the terminal ileum revealed chronic inflammation. At that time the patient was suspected to have Crohn's disease but was not treated as she did not follow up with a gastroenterologist. One year later as she remained symptomatic, the patient's primary care physician referred her to a gastroenterologist for suspected Crohn's disease. She underwent repeat colonoscopy to confirm the diagnosis. Terminal ileal ulcers were again seen and biopsy results revealed metastatic breast cancer. Discussion: Breast cancer may metastasize anywhere within the GI tract. In one retrospective review, it was estimated that breast cancer metastasizing to the GI tract involved the small bowel in 19% of patients. The most common presentations that are reported are abdominal pain, obstruction and bowel perforation. The differential diagnosis of terminal ileal ulcers is broad. The most common etiologies are inflammatory bowel disease, infections and ischemia. However, metastatic breast cancer may affect the small bowel although it is rare. Clinicians should have a high index of suspicion in patients with metastatic breast cancer presenting with terminal ileal ulceration.

Recurrent Metastatic Breast Cancer Presenting as Frontoethmoid Sinusitis with Sagittal Sinus Thrombosis: A Case Report

Recurrent Metastatic Breast Cancer Presenting as Frontoethmoid Sinusitis with Sagittal Sinus Thrombosis: A Case Report

Metastatic breast cancer presenting as linitis plastica of the stomach

Early detection and treatment of breast cancer, leading to longer survival, has revealed the natural history of this disease process. Linitis plastica of the stomach is a potential long-term sequela of metastatic breast cancer. Here we present a case of metastatic breast cancer presenting as linitis plastica, as well as the treatment algorithm for this rare clinical entity. The world literature describes a clear pattern of linitis plastica for metastatic infiltrating lobular breast cancer and a discrete nodular pattern for infiltrating ductal cancer, in regard to metastasis to the stomach. To our knowledge, this is the first case of infiltrating ductal cancer presenting as linitis plastica of the stomach.

Metástasis hipotálamo-hipofisaria en paciente con cáncer de mama

Pan-hypopituitarism is an unusual initial clinical presentation of metastatic stage breast cancer. Breast and lung cancers are the most frequent sites in women and in men associated with parasellar metastasis and hypothalamic invasion.

Brain metastases from breast cancer: identification of a high-risk group.

Brain metastases from breast cancer are an uncommon initial presentation of metastatic breast cancer, but brain metastases commonly occur later in women's metastatic illness. The aims of this study were to document the type, frequency, and temporal occurrence of brain metastases from breast cancer as well as the survival of women with such metastases, and to attempt to identify a subgroup of women at high risk of brain metastases who may benefit from pre-emptive medical intervention. The radiological reports of all women presenting with metastases aged under 70 years who had subsequently died were examined. The type, frequency, temporal occurrence and survival with brain metastases were documented. Correlations were sought between the frequency of brain metastases and age at metastatic presentation, tumour grade, histological type and oestrogen receptor (ER) status. Of 219 patients who had died with metastatic disease and who were under 70 years of age at metastatic presentation, 49 (22%) developed brain metastases. The development of brain metastases was related to young age (P = 0.0002), with 43% of women under 40 years developing brain metastases. Brain metastases were more common in women whose tumours were ER negative (38%) compared with women with ER-positive disease (14%) (P = 0.0003). By combining age and ER status, it is possible to identify a group of women (age under 50 years and ER negative) with a 53% risk of developing brain metastases. This group included many women who had chemotherapy for visceral metastases, and 68% had either stable disease or disease response at other sites at the time of brain metastases presentation. It is possible to identify a subgroup of women with metastatic breast cancer at high risk of brain metastases who may benefit from pre-emptive medical intervention, such as screening or prophylactic treatment.

Metastatic breast cancer presenting as a GI bleed in a man

Metastatic breast cancer presenting as a GI bleed in a man

Metastatic breast cancer (19 years later) mimicking obstructing primary colon cancer

Breast cancer is a common malignancy in females in the U.S. with a 1 in 8 lifetime risk. Long-term survivors are at risk of developing metastatic disease most commonly involving the bones, lungs, central nervous system, and the liver. Metastatic breast cancer to the colon is quite rare and typically presents as widely metastatic disease. This case involves metastatic breast cancer presenting as colonic obstruction 19 years after the original diagnosis.

Metastatic Breast Cancer Presenting as Tolosa–Hunt Syndrome

Choroidal involvement is a well- recognized manifestation of metastatic disease, particularly from breast and lung primaries. However, breast cancer can involve other ocular structures. The two patients presented illustrate diffuse orbital involvement of the extraocular muscles, simulating Tolosa–Hunt syndrome. This association has not been reported previously. Both patients responded well to local radiotherapy.

Metastatic breast cancer presenting as heel pain.

The authors present a case of breast cancer metastasizing to the calcaneus that was confirmed by bone biopsy. The patient's complaint of heel pain provided the initial evidence of skeletal metastasis. Metastatic spread of cancer to the hand or foot (acrometastasis) is considered rare. However, the possibility of acrometastasis should be considered in any patient with a history of cancer presenting with skeletal pain, especially if the symptoms do not respond to therapy.

Metastatic breast cancer masquerading as gastrointestinal primary

Seven patients with metastatic breast cancer presenting as gastrointestinal primary are described. These included six gastric and one colonic lesions. None of the patients had known systemic metastases at the time of diagnosis. The mean age at presentation was 66.7 yr (range 55–78). Median interval between breast cancer and gastrointestinal metastasis diagnosis was 6 yr (range 0.25–12.5). Original breast cancer histology included infiltrating lobular cancer (n = 4), infiltrating ductal cancer (n = 1), and a mixed type (n = 2). All patients with gastric involvement presented with epigastric pain and early satiety; the patient with colonic involvement had heme-positive stool. In three cases of gastric tumor and the one case of colonic tumor presentation, a definitive diagnosis of metastatic breast cancer was only confirmed after surgical resection of a presumed primary gastric or colonic malignancy. In the other three cases, pathological diagnostic confirmation was obtained through endoscopic biopsies and comparison to breast biopsy material, and operative treatment was avoided in favor of systemic cytotoxic therapy. The diagnosis was confirmed through similarities between mammary and gastric histopathology with regard to growth pattern, hormone receptor status, or gross cystic disease fluid protein. A high level of suspicion for metastatic breast cancer and a detailed pathological analysis will help avoid unnecessary surgical treatment in patients with a history of mammary carcinoma presenting with a newly diagnosed gastrointestinal neoplasm.

Metastasis of Breast Carcinoma to a Primary Mucinous Cystadenocarcinoma of the Ovary

A case of a patient with breast cancer metastatic within the tumor stroma of a primary ovarian carcinoma is presented. This finding is to the best of our knowledge the first case reported. The encountered diagnostic problems are discussed. A distinct peroperative frozen section diagnosis on the large, cystic, partially necrotic ovarian mass was not possible because of sampling problems. A comparable immunohistochemical staining pattern of cells being CEA negative, OC-125 negative, and HMFG-1 positive was found in both the primary breast tumor and in the solid epithelial parts in the tumor stroma of the left-sided ovarian carcinoma, as well as in the stroma of the right ovary. Immunohistochemical findings in the left-sided epithelial cystic ovarian tumor showed, as expected, apical reactivity with antibodies directed against CEA, whereas OC-125 and HMFG-1 were negative. Ploidy analysis showed that the primary breast carcinoma and the stromal part of left ovarian malignancy had the same aneuploid stemlines (DNA index = 1.18). The epithelial lining of the cystic ovarium carcinoma not showing the presence of a metastatic lesion in its stroma showed the presence of a diploid GO, 1 population only. These results show that DNA flow cytometry and immunohistochemistry may be helpful in assessing the origin of the malignancies in this unusual double presentation of both metastatic breast cancer and primary ovarian carcinoma.