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Breast metastasis of ilial carcinoid tumor: Case report and literature review

Gupta C, Malani AK, Rangineni S - World J Surg Oncol (2006)

Bottom Line: They can be mistaken for primary breast carcinoma both clinically and radiologically, even with known history of carcinoid tumor elsewhere in the body.Their histological appearance may mimic ductal adenocarcinoma of the breast.However, the distinction is important due to differences in management and prognosis.

Affiliation: Department of Oncology, Heartland Regional Medical Center, St. Joseph, Missouri 64506, USA. hakgupta@yahoo.com

ABSTRACT

Background: Metastatic breast carcinoids are rare neoplasms. They can be mistaken for primary breast carcinoma both clinically and radiologically, even with known history of carcinoid tumor elsewhere in the body.

Case presentation: We report a case of unilateral breast metastasis from carcinoid tumor of the small intestine in a 52-year-old woman who was successfully treated by lumpectomy and radiation therapy. An extensive review of the literature reveals only a few cases of metastatic carcinoid to the breast from small intestinal primaries.

Conclusion: Clinical suspicion for metastasis should be high in a patient with breast mass and history of known carcinoid elsewhere in the body. Lumpectomy alone may be effective in these patients. Mastectomy and especially axillary dissection could be avoided. Their histological appearance may mimic ductal adenocarcinoma of the breast. However, the distinction is important due to differences in management and prognosis.

2A). Large nest of tumor infiltrating within breast parenchyma. Normal ducts are seen at the right of the image (H&E, 100×). 2B). The histology of the tumor (left half of image) is similar to that from the intestine. The malignant cells contain round to oval nuclei with vesicular chromatin, rare mitosis, and no necrosis (H&E, 400×).
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Figure 2: 2A). Large nest of tumor infiltrating within breast parenchyma. Normal ducts are seen at the right of the image (H&E, 100×). 2B). The histology of the tumor (left half of image) is similar to that from the intestine. The malignant cells contain round to oval nuclei with vesicular chromatin, rare mitosis, and no necrosis (H&E, 400×).

Mentions: She remained stable for three and one half years, when she discovered a lump in her left breast. Clinical examination revealed a firm mobile mass in the breast suspicious for tumor. Mammograms were significant for an irregular, marginated mass of 2.2 × 2.0 cm in the upper inner quadrant of the left breast. An ultrasound confirmed these findings, revealing a hypoechoic, irregularly marginated mass highly suspicious for malignancy. The patient underwent lumpectomy of the breast mass for a definitive diagnosis. The gross specimen had a tan grey firm nodule of 2.5 × 1.5 × 1.5 cm with smooth borders within otherwise unremarkable fatty tissue. Histological examination revealed a 2.5 cm nodule containing infiltrating cords and nests of cells morphologically similar to her original ileal carcinoid tumor. The larger nests demonstrated an acinar pattern with rosette formation. The cells contained round to oval nuclei with a fine reticular chromatin pattern (Figure 2A and 2B). Necrosis was absent and mitoses were rare. Focally margins were positive for tumor. A partial mastectomy was performed to remove residual tumor. The patient received adjuvant radiation therapy to the affected breast. She has had no recurrences and has had stable liver disease (metastatic carcinoid) for 5 years following her breast surgery.

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Breast metastasis of ilial carcinoid tumor: Case report and literature review

Gupta C, Malani AK, Rangineni S - World J Surg Oncol (2006)

2A). Large nest of tumor infiltrating within breast parenchyma. Normal ducts are seen at the right of the image (H&E, 100×). 2B). The histology of the tumor (left half of image) is similar to that from the intestine. The malignant cells contain round to oval nuclei with vesicular chromatin, rare mitosis, and no necrosis (H&E, 400×).
© Copyright Policy - open-access
Figure 2: 2A). Large nest of tumor infiltrating within breast parenchyma. Normal ducts are seen at the right of the image (H&E, 100×). 2B). The histology of the tumor (left half of image) is similar to that from the intestine. The malignant cells contain round to oval nuclei with vesicular chromatin, rare mitosis, and no necrosis (H&E, 400×).
Mentions: She remained stable for three and one half years, when she discovered a lump in her left breast. Clinical examination revealed a firm mobile mass in the breast suspicious for tumor. Mammograms were significant for an irregular, marginated mass of 2.2 × 2.0 cm in the upper inner quadrant of the left breast. An ultrasound confirmed these findings, revealing a hypoechoic, irregularly marginated mass highly suspicious for malignancy. The patient underwent lumpectomy of the breast mass for a definitive diagnosis. The gross specimen had a tan grey firm nodule of 2.5 × 1.5 × 1.5 cm with smooth borders within otherwise unremarkable fatty tissue. Histological examination revealed a 2.5 cm nodule containing infiltrating cords and nests of cells morphologically similar to her original ileal carcinoid tumor. The larger nests demonstrated an acinar pattern with rosette formation. The cells contained round to oval nuclei with a fine reticular chromatin pattern (Figure 2A and 2B). Necrosis was absent and mitoses were rare. Focally margins were positive for tumor. A partial mastectomy was performed to remove residual tumor. The patient received adjuvant radiation therapy to the affected breast. She has had no recurrences and has had stable liver disease (metastatic carcinoid) for 5 years following her breast surgery.

Bottom Line: They can be mistaken for primary breast carcinoma both clinically and radiologically, even with known history of carcinoid tumor elsewhere in the body.Their histological appearance may mimic ductal adenocarcinoma of the breast.However, the distinction is important due to differences in management and prognosis.

Affiliation: Department of Oncology, Heartland Regional Medical Center, St. Joseph, Missouri 64506, USA. hakgupta@yahoo.com

ABSTRACT

Background: Metastatic breast carcinoids are rare neoplasms. They can be mistaken for primary breast carcinoma both clinically and radiologically, even with known history of carcinoid tumor elsewhere in the body.

Case presentation: We report a case of unilateral breast metastasis from carcinoid tumor of the small intestine in a 52-year-old woman who was successfully treated by lumpectomy and radiation therapy. An extensive review of the literature reveals only a few cases of metastatic carcinoid to the breast from small intestinal primaries.

Conclusion: Clinical suspicion for metastasis should be high in a patient with breast mass and history of known carcinoid elsewhere in the body. Lumpectomy alone may be effective in these patients. Mastectomy and especially axillary dissection could be avoided. Their histological appearance may mimic ductal adenocarcinoma of the breast. However, the distinction is important due to differences in management and prognosis.

View Similar Images In: Results  - Collection
View Article: PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=1481627&rFormat=json&query=null&req=5