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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 75-76

Secondaries mimicking primary cancers of breast: A report of four cases


1 Department of Pathology, Sagar Dutta Medical College, Kolkata, India
2 Department of Pathology, Bankura Sammilani Medical College, Bankura, West Bengal, India
3 Department of Pathology, Saroj Gupta Cancer Centre and Research Institute, Kolkata, India

Date of Web Publication16-Jun-2017

Correspondence Address:
Anindya Adhikari
Basudevpur, P. O: Banipur, P. S- Sankrail, Howrah - 711 304, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_96_16

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  Abstract 

Metastatic malignant tumors rarely affect the breast and constitute about 2% of all breast tumors. Herein, we report four such cases of metastatic breast neoplasms. All cases were initially diagnosed by fine-needle aspiration (FNA). Three of them showed features of poorly differentiated adenocarcinoma and one had features of malignant melanoma. Later on, thorough clinical examination aided by ancillary investigations and finally confirmed by immunohistochemistry (IHC) or immunocytochemistry disclosed actual diagnoses. Sigmoid colon, lung, and ovary were primary in the first three cases, respectively. In the last case, FNA confirmed the diagnosis to be malignant melanoma of foot as primary.

Keywords: Breast, fine-needle aspiration, malignant, secondary


How to cite this article:
Mandal PK, Adhikari A, Biswas S, Roy S. Secondaries mimicking primary cancers of breast: A report of four cases. Arch Med Health Sci 2017;5:75-6

How to cite this URL:
Mandal PK, Adhikari A, Biswas S, Roy S. Secondaries mimicking primary cancers of breast: A report of four cases. Arch Med Health Sci [serial online] 2017 [cited 2019 Jun 17];5:75-6. Available from: http://www.amhsjournal.org/text.asp?2017/5/1/75/208213




  Introduction Top


Metastatic breast tumors are uncommon, comprising about 2% of all breast tumors.[1] Non-Hodgkin's lymphoma and melanoma are the most common nonepithelial metastasis. Other breast, lung, ovary, kidney, and gastrointestinal tract are the common origins of epithelial malignancy.[2],[3],[4],[5] Contralateral breast is the most common source of primary.[6]


  Case Reports Top


Case 1

A 35-year-old female presented with 1.5 cm lump in her left breast. Cytology revealed a poorly differentiated adenocarcinoma. Immunohistochemistry (IHC) following biopsy showed CK20 positivity and CK7 negativity. She had gradually increasing constipation. Colonoscopy revealed a proliferative mass in the sigmoid colon which was proved to be adenocarcinoma in biopsy later on. At present, she is having chemotherapy.

Case 2

A 45-year-old female presented with a superficial lump in her right breast. She was a smoker and had chronic cough with occasional hemoptysis. She had pallor and grade 3 clubbing. Breast examination revealed a superficial mobile lump of 2.5 cm in diameter without lymphadenopathy. Computed tomography (CT) scan discovered a right lung tumor. FNA of the breast lump diagnosed it as an undifferentiated carcinoma [Figure 1]a. Immunocytochemistry (ICC) showed chromogranin positivity [Figure 1]b, proving it to be metastatic small-cell carcinoma of the lung. Later on, she was lost to follow-up.
Figure 1: (a) Fine-needle aspiration picture of metastatic small-cell carcinoma (LG ×400). (b) Immunocytochemistry picture of small-cell carcinoma showing chromogranin positivity (×400)

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Case 3

A 38-year-old female attended outpatient department with ascites for 3 months and right breast lump for 6 weeks. FNA of the breast lump showed poorly differentiated adenocarcinoma. Ultrasonography (USG) of the abdomen revealed an ovarian tumor. Her serum CA-125 level came out to be 585 IU/ml (normal value < 35 IU/ml). Biopsy from the ovarian tumor showed a poorly differentiated serous adenocarcinoma. IHC was positive for pan Keratin and CK7 while negative for CK20. The patient developed diffuse metastases very soon.

Case 4

A 59-year-old female presented with a right breast lump. She also had a blackish right foot ulcer and right inguinal lymphadenopathy. FNA of the breast lump as well as the inguinal node showed features of a metastatic melanoma [Figure 2]a. The subsequent biopsy with IHC showed HMB 45 positivity [Figure 2]b and cytokeratin negativity, proving it to be metastatic melanoma. She underwent surgery over foot and later on discontinued treatment.
Figure 2: (a) Fine-needle aspiration picture of metastatic melanoma (LG ×400). (b) Immunohistochemistry picture of melanoma showing HMB 45 positivity (×400)

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  Discussion Top


Spread to the breast from primary tumors of other sites is a well-recognized entity. However, the affection is rare and is seen when the disease is disseminated widely.[7] Most common secondary tumors of the breast are lymphoma/leukemia, melanoma, carcinoma of lung (small cell variety mainly), stomach, prostate, ovary, and kidney. Neuroendocrine type of carcinoma seems to have a definite predilection for metastasis to breast. The presence of in situ carcinoma goes in favor of primary,[8] and the absence of elastosis documents metastatic lesion.[9] Sarcomas, especially alveolar rhabdomyosarcoma, can also metastasize to breast. Metastasis to the breast from extramammary malignancies usually presents as easily palpable, rapidly growing, well–circumscribed, rounded masses, most often located in the upper outer quadrant usually without overlying skin involvement or nipple retraction.[2] Metastatic tumor in the breast is at first a solitary lesion in about 85% of cases.[10] Multiple (10%) or diffuse (5%) involvement initially, eventually become bilateral in about 25% of patients. Metastases have been described in ipsilateral axillary lymph nodes in 25% to 48% of patients.[10] Mammographic evaluation and ancillary investigations such as USG, CT scan, and colonoscopy can be useful in the differential diagnosis of primary versus secondary breast cancer.

Saroj Gupta Cancer Centre and Research Institute supported the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Silverman JF, Feldman PS, Covell JL, Frable WJ. Fine needle aspiration cytology of neoplasms metastatic to the breast. Acta Cytol 1987;31:291-300.  Back to cited text no. 1
    
2.
Georgiannos SN, Chin J, Goode AW, Sheaff M. Secondary neoplasms of the breast: A survey of the 20th century. Cancer 2001;92:2259-66.  Back to cited text no. 2
    
3.
Alvarado Cabrero I, Carrera Alvarez M, Pérez Montiel D, Tavassoli FA. Metastases to the breast. Eur J Surg Oncol 2003;29:854-5.  Back to cited text no. 3
    
4.
Rosen PP, editor. Metastases in the breast from non-mammary malignant neoplasms. In: Rosen's Breast Pathology. Philadelphia, PA: Lippincott Williams and Wilkins; 2001. p. 689-701.  Back to cited text no. 4
    
5.
David O, Gattuso P, Razan W, Moroz K, Dhurandhar N. Unusual cases of metastases to the breast. A report of 17 cases diagnosed by fine needle aspiration. Acta Cytol 2002;46:377-85.  Back to cited text no. 5
    
6.
Lester SC. The breast. In: Kumar VK, Abbas AK, Fausto N, Aster JC, editors. Robbins & Cotran Pathologic Basis of Diseases. 8th ed. Pennsylvania: Elsevier; 2010. p. 1093.  Back to cited text no. 6
    
7.
Di Bonito L, Luchi M, Giarelli L, Falconieri G, Viehl P. Metastatic tumors to the female breast. An autopsy study of 12 cases. Pathol Res Pract 1991;187:432-6.  Back to cited text no. 7
    
8.
Ellis IO, Pinder SE, Lee A. Tumors of the breast. In: Fletcher CD, editor. Diagnostic Histopathology of Tumors. 3rd ed., Vol. 1. China: Churchill Livingstone Elsevier; 2007. p. 960.  Back to cited text no. 8
    
9.
Azzopardi JG. Problems in breast pathology. In: Bennington JL, editor. Major Problems in Pathology. Vol. 11. Philadelphia: W.B. Saunders; 1979.  Back to cited text no. 9
    
10.
Toombs BD, Kalisher L. Metastatic disease to the breast: Clinical, pathologic, and radiographic features. AJR Am J Roentgenol 1977;129:673-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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