Pulmonary Metastatic Lesions Research Articles

Angiosarcoma of the Scalp: Metastatic Pulmonary Cystic Lesions Initially Misinterpreted as Benign Findings on 18F-FDG PET/CT.

Angiosarcomas are rare and only represent about 2% of all soft tissue sarcomas. They arise from vascular or lymphatic endothelial cells and are most commonly located in the heart, liver, breast, and skin. Cutaneous angiosarcoma of the scalp is highly malignant and with dismal prognosis. Reported five-year survival is <30%. The mainstay of treatment is surgical resection and adjuvant radiation therapy, but failure rates following local therapy are high. Cutaneous angiosarcoma of the scalp has a predilection for pulmonary metastases with a variety of morphologic patterns on imaging. Metastatic disease in terms of pulmonary thin-walled, cystic lesions, may not be hypermetabolic on 18F-FDG PET and, as such, could be misinterpreted as benign findings. We present a case demonstrating the diagnostic uncertainty and delay in an elderly male with angiosarcoma of the scalp presenting with metastatic lung lesions following failure of local therapy.

PO132 APOPTOTIC ACTIVITIES OF RECOMBINANT CELL SURFACE RECEPTOR FAS WITHIN TUMOR MICROENVIRONMENT OF BREAST CARCINOMA

s / The Breast 24 S3 (2015) S21–S75 S67 Results: The median age of primary breast cancer diagnosis was 53 years (range, 32 to 67). One patient had clinical stage I disease, 6 patients were stage IIA, 5 patients were stage IIB, one patient was stage IIIA. The median interval from primary breast cancer diagnosis to pulmonary metastasis diagnosis was 75 months. The concordance rate of ER status between primary and pulmonary metastatic tumors was 77.1%, PgR status was 62.0%, HER2 status was 100% and there was no negative-to-positive change. The median survival time after pulmonary metastasis of 3 patients who had positive-to-negative in ER status was 16 months. 7 patients of 8 patients who had ER positive in also primary and pulmonary metastatic tumors had started endocrine therapy; the median survival time after pulmonary metastasis of the 7 patients was 54 months. While the median survival time after pulmonary metastasis of the patients with which PgR status accorded was 64 months, the patients with which PgR status discorded was 46 months. Conclusion: The patients who have positive-to-negative in ER status are worse prognosis, and a possibility that an endocrine therapy is invalid is considered. However, the patients who have ER positive in also primary and pulmonary metastatic tumors can continue an endocrine therapy for long time, and obtain a long prognosis. The biopsy of pulmonary metastatic lesion will bring a prognosis prediction and sometimes help the decision of treatment strategy.

Successful Percutaneous Thrombectomy of Aortic Tumor Emboli Extending into the Origin of the Superior Mesenteric Artery with Half-Deployment of a Nitinol Stent

A 73-year-old woman with leiomyosarcoma presented with a 3-day history of abdominal pain. An abdominal computed tomography (CT) scan revealed a 1.5-cm abdominal aortic mass extending into the origin of the superior mesenteric artery (SMA) (arrow in Fig 1). Chest CT scan showed tumor thrombi in the left superior pulmonary vein and left atrium (straight and right-angle arrows in Fig 2) and multiple metastatic lesions in both lungs (arrowheads in Fig 2) and the left fourth rib (curved arrow in Fig 2). Together, these findings indicated that a pulmonary metastatic lesion had invaded the pulmonary vein and caused systemic tumor embolization. Aortography performed through a transfemoral 45-cm 8-F sheath (Super Arrow-Flex sheath; Arrow International, Inc, Reading, Pennsylvania) showed a filling defect at the SMA origin (arrow in Fig 3). A 16-F sheath (St. Jude Medical, Minnetonka, Minnesota) was inserted through the contralateral femoral artery using a “preclosure” technique. A 16-mm diameter self-expanding closed cell nitinol stent (Niti-S; Taewoong Medical Co, Ltd, Gimpo, Korea) was advanced through the sheath and halfdeployed, caudally, to capture emboli. A 6-F 20-mm thrombectomy-type

Clinical Significance of Multiple Pulmonary Metastasectomy for Hepatocellular Carcinoma.

The lung is the most common site of extrahepatic metastasis from hepatocellular carcinoma (HCC). The aim of this study was to evaluate the significance and long-term outcomes of pulmonary metastasectomy for HCC, especially in patients with multiple nodules or repeated pulmonary recurrence. We retrospectively analyzed 19 patients who underwent pulmonary metastasectomy for HCC at our institution from 1993 to 2013. No in-hospital mortality occurred. The 19 patients included 14 men. The median age was 61 (range 20-76) years. Eight patients (42 %) had single pulmonary metastatic lesions, whereas 4 (21 %) had >10 lesions. Median follow-up after pulmonary metastasectomy was 23.1 (6.3-230) months. Twelve patients died, and the cause of death was HCC progression in nine. The 1-, 3-, 5-, and 10-year overall survival rates after pulmonary metastasectomy were 89, 48, 48, and 21 %, respectively. Seven patients developed pulmonary recurrence after initial pulmonary metastasectomy. Five of the seven underwent repeat metastasectomy, with a median survival time of 65 months, and 2- and 3-year survival rates of 100 and 67 %, respectively. The 2- and 3-year survival rates in the four patients with >10 pulmonary nodules were 75 and 50 %, respectively. Surgical resection is a safe and effective treatment in selected patients with pulmonary metastasis from HCC, even in those with multiple nodules. Repeated locoregional therapy for lung recurrence might help to improve survival in these patients.

Current role of computed tomography-guided transthoracic needle biopsy of metastatic lung lesions.

As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases.

Pulmonary metastasectomy in uterine malignancy: outcomes and prognostic factors.

ObjectiveThe aim of this study was to investigate outcomes in uterine cancer patients undergoing pulmonary metastasectomy and prognostic factors associated with survival after the procedure.MethodsA retrospective study was performed in 29 uterine cancer patients who underwent surgical resection of pulmonary metastatic lesions at Samsung Medical Center between June 1995 and December 2011.ResultsHistopathology showed carcinoma in 17 patients (58.6%) and sarcoma in 12 patients (41.4%). Of the 29 patients, 17 (58.6%) had less than three pulmonary metastatic lesions. Eight (27.6%) had symptoms related to lung metastasis. The 5-year survival rate after pulmonary metastasectomy for the entire cohort was 48.2%. On univariate and multivariate analysis, the presence of pulmonary symptoms and more than three lesions of metastasis were associated with poor survival after pulmonary metastasectomy.ConclusionPulmonary metastasectomy for uterine cancer is an acceptable treatment in selected patients. Patients with more than three pulmonary metastatic lesions and pulmonary symptoms related to lung metastasis could expect to have worse prognosis after pulmonary metastasectomy.

Expression of a disintegrin and metalloprotease 8 and endostatin in human osteosarcoma: Implication in tumor progression and prognosis

BackgroundA disintegrin and metalloprotease 8 (ADAM8) is a trans-membrane protein, which is involved in cell adhesion, signaling and migration as well as the proteolytic cleavage of various substrates. Endostatin is a potent inhibitor of angiogenesis. ADAM8 and Endostatin have been associated with multiple malignancies. However, their role in osteosarcoma is not fully elucidated. AimTo determine the expression of ADAM8 and endostatin in osteosarcoma and to study their correlation with different clinicopathological parameters and patients’ outcomes. Material and methodsADAM8 and endostatin expression were immunohistochemically evaluated in 61 primary osteosarcomas and 11 pulmonary metastatic osteosarcoma lesions. ResultsAmong 61 primary osteosarcomas, ADAM8 was detected in 52 tumors (85.2%) and highly expressed in 33 cases (54.1%). Positive endostatin expression was found in 28 tumors (45.9%). Higher ADAM8 and decreased endostatin expression rates in metastatic lesions compared to primary osteosarcoma were found but these differences were not statistically significant (p=0.086 & 0.558 respectively). High ADAM8 expression score and positive endostatin expression were significantly correlated with tumor size, stage and distant metastasis (p<0.05). Survival analysis showed that high ADAM8 expression was associated with poor overall survival (OS) (p=0.0002). Multivariate analysis revealed that ADAM8 expression level was an independent prognostic parameter for the OS (p=0.017). ConclusionOur data suggest that ADAM8 and endostatin play a role in osteosarcoma progression. High ADAM8 expression serves as a reliable marker for poor prognosis in osteosarcoma patients.

A Translational Phase 2 Study of Cabozantinib in Men with Metastatic Castration Resistant Prostate Cancer with Visceral Metastases with Characterization of Circulating Tumor Cells and Large Oncosomes

ABSTRACT Aim: Cabozantinib (XL184) is a potent multi-targeted tyrosine kinase inhibitor (TKI) that is under active investigation in several malignancies including prostate cancer (PC). The mechanism of action in PC has not been well characterized at this time. While considerable attention has been given to the impact of this agent on Tc-bone scans, less is known about its activity in men with visceral metastases. Methods: This study was designed as a single arm phase 2 study of cabozantinib 60 mg daily for men with visceral disease. The primary endpoint of this study is clinical benefit rate at 12 weeks (CBR12) which included stable disease and radiographic response. PSA was not used as an endpoint. Beyond standard clinical assessments, blood and urine were collected for circulating tumor cell (CTC) assessments using CellSearch (CS) and NanoVelcro (NV) chips and large oncosome selection. Biopsies before treatment and at progression are being collected when possible. Circulating tumor cell RNA and large oncosome content were profiled at baseline and 2 weeks for all patients. Results: Eight pts. have been treated of the anticipated 40 patient cohort. 13% had pulmonary metastatic lesion; 88% had hepatic metastases; 88% had concurrent osseous metastases. CBR12 was 83% at the time of this report. Two patients discontinued treatment without evidence of progression due to grade 3 toxicity (diarrhea, corneal defect). Discordant responses were noted between visceral metastases and bone scans. Other grade 3 toxicities included hypertension, hand-foot syndrome, and GGT. CTC numbers by NV and CS declined within 2 weeks and increased at progression. Updated results of CTC and oncosome analysis will be presented including alterations in MET and SChLAP1 expression. Conclusions: Cabozantinib is a TKI with activity in PC even in men with visceral metastasis who are typically considered to have more aggressive disease. The activity in the viscera appears to be lower than that seen in osseous metastases. Further understanding of the biology of cabozantinib based on CTC, oncosomes, and tissue studies will refine our use of this active agent. Disclosure: L.W.K. Chung: research funding from Exelixis. All other authors have declared no conflicts of interest.

Spontaneous pneumothorax after intensive chemotherapy in endometrial cancer: A rare complication

ObjectiveEndometrial cancer with hematogenous metastases can be treated with chemotherapy. We present a case of spontaneous pneumothorax that occurred when a solitary pulmonary endometrial metastatic lesion was treated with paclitaxel plus carboplatin. Case reportA 38-year-old female had stage II endometrial endometrioid adenocarcinoma. Solitary bilateral pulmonary metastases developed after primary treatment. Complete remission accompanied by a right spontaneous pneumothorax occurred during chemotherapy with paclitaxel plus carboplatin. ConclusionRapid shrinkage of a pulmonary space-occupying tumor sometimes causes rare but life-threatening spontaneous pneumothoraces. We report the first case of a spontaneous pneumothorax after using paclitaxel plus carboplatin in the treatment of endometrial cancer.

Mesenchymal Stromal Cell Dependent Regression of Pulmonary Metastasis from Ewing's.

Introduction: Ewing’s sarcoma (ES) is the second most common bone tumor in children. Survival has not improved over the last decade and once pulmonary metastatic disease is present, survival is dismal. Mesenchymal stromal cell (MSC) therapy has shown potential benefit for Kaposi’s sarcoma; however, the role of progenitor cell therapies for cancer remains controversial. MSC treatment of ES or pulmonary metastatic disease has not been demonstrated. We have developed an orthotopic xenograft model of ES in which animals develop spontaneous pulmonary metastases. Within this model, we demonstrate the use of MSCs to target ES lung metastasis.Materials and Methods: Human ES cells were transfected with luciferase and injected into the rib of nude mice. Development of pulmonary metastases was confirmed by imaging. After flow cytometry based characterization, MSCs were injected into the tail vein of nude mice with established local ES tumor or pulmonary metastasis. Mice were treated with intravenous MSCs weekly followed by bioluminescent imaging.Results: The intravenous injection of MSCs in an ES model decreases the volume of pulmonary metastatic lesions; however, no effect on primary chest wall tumor size is observed. Thus verifying the MSC preferential homing to the lung. MSCs are found to “home to” the pulmonary parenchyma and remain engrafted up to 5 days after delivery.Discussion: MSC treatment of ES slows growth of pulmonary metastasis. MSCs have more affinity for pulmonary metastasis and can effect a greater decrease in tumor growth in the lungs compared to the primary tumor site.

Clinical effectiveness of recombinant adenovirus-p53 combined with radiotherapy in advanced soft tissue sarcoma: A report of 37 cases.

e21514 Background: To evaluate the efficacy and safety for the treatment of advanced soft tissue sarcoma with recombinant human adenovirus p53 (rAd-p53, Gendicine) injection and radiotherapy. Methods: From October 1, 2001, to May 1, 2013, 37 advanced soft tissue sarcoma patients have been treated with rAd-p53 plus radiotherapy. Gene therapy: multipoint injection of rAd-p53 within the neoplasm was given to head and neck as well as abdominal and pelvic tumor by ultrasound guided and to pulmonary metastatic lesion by CT guided. rAd-p53 was injected or perfused 1 × 1012 VP / 2 ml once a week for 3-16 weeks, and the average was 7 ± 2 weeks. Radiotherapy: radiotherapy was delivered 48-72 hours after the first rAd-p53 perfusion to a cumulative dose of 16-70 Gy / 8-35 fractioins / 2-7 weeks (average dose, 52.0 ± 5.0 Gy). Results: The rates of CR, PR, SD accounted for 8.1% (3/37), 43.2% (16/37) and 48.6% (18/37), respectively. All 18 patients of SD achieved the purpose of relieving pain and reducing local symptoms. The median follow-up time was 21 months (range, 6 to 116 months). The median overall survival (OS) and time to progression (TTP) times were 18.0 months and 13.6 months, respectively. The 1-,2-, 3- and 5-year OS rates were 56.8% (21/37), 21.6% (8/37), 16.2% (6/37) and 10.8% (4/37), respectively. Among all 39 patients who accepted rAd-p53 injection for several times, there were no significant adverse events except temporary fever. Conclusions: It is effective and safe for soft tissue sarcoma patients using the treatment of rAd-p53 weekly injection with concurrent radiotherapy. The rAd-p53 is a potential gene therapy drug for the treatment of soft tissue sarcoma.

A case of septic pulmonary embolism associated with renal abscess mimicking pulmonary metastases of renal malignancy

We report the case of a 46-year-old woman with acute febrile symptom who had multiple pulmonary nodules and a renal mass. She underwent (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to find a hidden malignancy and the cause of her fever. FDG PET/CT images demonstrated a renal mass and multiple lung nodules with intense FDG uptake, which was suspicious of a renal malignancy with multiple pulmonary metastatic lesions. CT-guided biopsies of the pulmonary and renal lesions only showed chronic inflammatory infiltrates without evidence of malignancy. She was diagnosed with septic pulmonary embolism from a renal abscess. One month after antibiotic treatment, the follow-up chest and abdomen CT showed improvement of the lung and renal lesions. This is the first case demonstrating the FDG PET/CT finding of septic pulmonary embolism associated with renal abscess in the published literature.

Errata for Docetaxel (Taxotere®)-induced cavitary change of pulmonary metastatic lesions complicated by bilateral spontaneous pneumothoraces in a patient with primary adenocarcinoma of the lung; and Y-type partial duplication of a vaginal ectopic ureter with ipsilateral hypoplastic pelvic kidney and bicornuate uterus

Errata for Docetaxel (Taxotere®)-induced cavitary change of pulmonary metastatic lesions complicated by bilateral spontaneous pneumothoraces in a patient with primary adenocarcinoma of the lung; and Y-type partial duplication of a vaginal ectopic ureter with ipsilateral hypoplastic pelvic kidney and bicornuate uterus

Association of D2-40 and MMP-1 expression with cyst formation in lung metastatic lesions of cutaneous angiosarcoma on the scalp: immunohistochemical analysis of 23 autopsy cases

Cutaneous angiosarcoma of the scalp can rapidly develop into pulmonary metastasis. The pulmonary metastatic lesions display a unique appearance, so-called thin-walled cysts, which cause a fatal relapsed pneumothorax by rupturing. We analyzed 23 autopsy cases of angiosarcoma with pulmonary metastasis to elucidate the mechanism of the thin-walled cyst development. Of the 23 cases of cutaneous angiosarcoma of the scalp with pulmonary metastasis, radiological examination revealed pulmonary metastatic lesions as thin-walled cysts (39%), nodules (39%), mixed cysts and nodules (13%), and ground-glass opacity (9%). All the cases but one with cystic metastases were complicated by pneumothorax. The cystic lesions were accompanied by podoplanin (D2-40)-positive tumor cells in the luminal surface of the cysts. In both primary cutaneous lesions and pulmonary metastatic lesions, the D2-40 expression was positive for angiosarcoma cells in 100% and 92% of the cases, respectively. While the estrogen-regulated gene (ERG) expression was also positive for most of the primary and metastatic pulmonary angiosarcomas, D2-40 was a more useful marker to differentiate tumor cells from the background than was the ERG expression of the vascular endothelium. Matrix metalloproteinase-1 (MMP-1) expression was also predominant in primary lesions (95%) and pulmonary metastatic lesions (82.6%). Proteinases, like MMP-1, might be associated with a developing thin-walled cyst, although there were no differences in the MMP-1 expression in either the cystic or nodular metastasis. Two extremely aggressive cases showed cystic metastasis with central necrosis that was not observed in other cases. These results suggest a pathogenesis of thin-walled cysts in some progressive cases.

Segment hepatic herniation through a diaphragm defect simulating basal lung nodes

Methods A 51 year old female non-smoker, who had high blood pressure, was diagnosed with left lobe liver abscess, was suspicioned as carcinoma of pancreatic head. Definitive diagnosis was liver abscess and basal right lung node. Additional thoracic tests included a CT without contrast showing a node in the right lung inferior lobe, measuring 4x3 cm in diameter anterio-posteriorly and 4x5 cm in diameter transversally. Respiratory function tests were optimal; thus it was decided to achieve a diagnostictherapeutical surgical procedure of the lung nodes in order to make a differential diagnosis of primary pulmonary tumor or metastatic lesions of another type of lesion in liver.

Endobronchial metastasis in a dog with sarcoma

A 3-year-old neutered male Australian Shepherd mix dog presented with metastatic soft tissue sarcoma arising from a primary tumor in the left lumbar fascia. Two separate metastases to the lungs were characterized by neoplasia within bronchiolar walls, which caused obstruction of the bronchiolar lumina and atelectasis of adjacent alveoli, a characteristic feature of endobronchial metastasis. Neoplastic cells of the primary lumbar neoplasm, metastatic pulmonary lesions, and additional widespread metastatic masses identified postmortem were similarly immunoreactive for vimentin, but non-immunoreactive for cytokeratin, cluster of differentiation 18, synaptophysin, chromogranin, and desmin. The present report describes a naturally occurring case of endobronchial metastasis in a dog.

Docetaxel (Taxotere®)-induced cavitary change of pulmonary metastatic lesions complicated by bilateral spontaneous pneumothoraces in a patient with primary adenocarcinoma of the lung

Pneumothorax is a complication that rarely occurs after chemotherapy for lung cancer. We report the chest computed tomography findings of a case of spontaneous pneumothorax complicating docetaxel (Taxotere®) treatment for pulmonary metastasis in a 70-year-old woman with pulmonary adenocarcinoma. The patient developed bilateral pneumothoraces, which was induced by changes in the cavitary pulmonary metastatic lesions, after systemic chemotherapy with docetaxel. The chest computed tomography findings and possible mechanisms of this unusual complication are discussed in this report.

Outcome Prediction of Pulmonary Metastasectomy Can Be Evaluated Using Metastatic Lesion in Osteosarcoma Patients

We investigated whether molecular prognostic factors should be evaluated in specimens of the primary or the metastatic lesion and if the prognosis after initial pulmonary metastasectomy can be predicted based on evaluation of metastatic lesion specimens in osteosarcoma patients. This retrospective study included 29 osteosarcoma patients with pulmonary metastases (19 males, 10 females; age 21 ± 10 years). Molecular prognostic factors were the levels of vascular endothelial growth factor type A (VEGF-A), VEGF type C (VEGF-C), and Ki67. Primary and pulmonary metastatic lesions could be compared in 18 patients regarding the values of marker expressions and the prognosis after initial pulmonary resection. Finally, the prognosis of all 29 cases was compared according to the molecular markers of the metastatic lesions. Evaluation of the metastatic lesions reflected the prognosis after pulmonary metastasectomy more than that of the primary lesions. In the metastatic lesions, positive expression of VEGF-A (n = 15), VEGF-C (n = 2), and Ki67 (n = 15) was associated with a significantly poorer prognosis (p = 0.0013, 0.0001, and 0.037, respectively). No patients with positive expression of both VEGF-A and Ki67 (n = 7) survived more than 5 years after the initial pulmonary resection. All patients who had negative reactions to both VEGF-A and Ki67 (n = 6) were alive at the end of the study. Molecular prognostic factors should be investigated in specimens of the metastatic lesion. Combined evaluation of VEGF-A and Ki67 and of VEGF-C using pulmonary metastatic lesion specimens in osteosarcoma patients effectively reflects survival after pulmonary metastasectomy.

Study of survival in patients with malignant lung lesions treated with radiofrequency

To report on the survival of a series of patients with primary and metastatic lung tumours treated with radiofrequency (RF). Four years ago we published our preliminary experience with the use of this technique. For a period of 8 years we have treated 59 patients (by means of a total of 70 procedures) with primary or metastatic pulmonary neoplastic lesions, which fulfilled inclusion criteria to perform the technique. They were in all cases non-surgical lesions that had been either previously treated or not. The technique was performed in the radiology suite, under conscious analgo-sedation. We treated primary pulmonary lesions, neoplastic recurrences, or metastases with curative or palliative intention (pain management). Current global survival rate is 19 patients (32 %) with a mean of 26.61 ± 3.17 months (range: 20.38 ± 32.83) and a median of 16.00 ± 3.57 (range: 8.99-23.00). If we establish the difference between primary and metastatic tumours, mean survival is 27.62 ± 4.12 months in primary tumours (median: 16.00) vs. 24.65 ± 4.47 months in metastatic tumours (median: 16.00). When we studied the survival in those cases with a curative intent, mean survival in primary tumours was 30.97 ± 4.57 months (median: 21.00) vs. 25.14 ± 4.68 (median: 16.00) months in metastatic tumours. RF ablation of lung lesions is a minimally invasive procedure that is useful in primary tumours (especially in stage I) and metastatic ones. RF has proven its usefulness in the multidisciplinary treatment of this pathology due to the low incidence of serious complications and survival obtained, considering that patients are elderly with significant comorbidity.

The discordance between primary breast cancer lesions and pulmonary metastatic lesions in expression of aldehyde dehydrogenase 1-positive cancer cells

We evaluated the expression of aldehyde dehydrogenase 1 (ALDH1) between primary breast lesions and pulmonary metastatic (PM) lesions in breast cancer patients. We retrospectively analyzed the clinicopathological features and the expression statuses of ER, PR, HER2, Ki-67 and ALDH-1 in both primary and metastatic breast cancer lesions and evaluated the discordance rates in the expressions of these markers between the primary and metastatic lesions, and also the prognostic value of these factors. None of the PM patients had metastases at any other sites, and all had undergone curative breast cancer surgery. The pulmonary operation was partial resection in 15 (88 %) patients and lobectomy in 2 (12 %) patients. The median overall survival (OS) after resection of the PNs (OS) was 48 months. The discordance rates in the expressions of ER, PR, HER2, Ki67 and ALDH-1 between the primary and metastatic lesions were 0, 29, 21, 43 and 50 %, respectively. There was significant discordance in the biomarkers between the primary tumors and the metastatic lesions.