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Role of treatment for solitary pulmonary nodule in breast cancer patients.

Kitada M, Sato K, Matsuda Y, Hayashi S, Miyokawa N, Sasajima T - World J Surg Oncol (2011)

Bottom Line: In 14 of these patients, video-assisted thoracoscopic surgery was performed to remove a SPN.The tumor grading based on pathological diagnosis was T1N0M0, p-Stage 1A in all 3 patients.The prognosis was good in the breast cancer patients in whom the metastatic lung tumor was a SPN.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1 Asahikawa Hokkaido 078-8510, Japan. k1111@asahikawa-med.ac.jp

ABSTRACT

Background: Metastatic pulmonary tumors secondary to breast cancer detected either before or after surgery are predominantly multiple and bilateral. However, in cases detected to have a solitary pulmonary nodule (SPN), determining whether the lesion represents a primary cancer, metastasis, or a benign pulmonary lesion can be difficult.

Materials and methods: Between January 2000 and December 2009, we performed breast cancer surgery on 1,226 patients, of which 49 cases (3.9%) were detected to have pulmonary lesions before or after the surgery. In 14 of these patients, video-assisted thoracoscopic surgery was performed to remove a SPN.

Result: Pathological examination of the resected specimens in these 14 cases revealed metastatic pulmonary tumor in 8 cases, primary lung cancer in 3 cases, and benign disease in 3 cases. While lobectomy was performed in one of these patients with metastatic pulmonary tumor, the remaining 7 underwent partial resection of the lung. The primary lung cancer was an adenocarcinoma in all 3 patients, and lobectomy plus mediastinal lymph node dissection was performed in these patients. The tumor grading based on pathological diagnosis was T1N0M0, p-Stage 1A in all 3 patients. The prognosis was good in the breast cancer patients in whom the metastatic lung tumor was a SPN.

Conclusion: Evaluating the immunohistochemical cytokeratin profile and levels of the TTF-1 and GCDFP-15 of the lesion was useful when distinguishing between pulmonary cancer and metastatic pulmonary tumor. In addition, some patients exhibited changes in the biological properties of the metastatic tumor, and delete tumor resection by video-assisted thoracoscopic surgery can be useful for deciding the drug treatment strategy in some cases.

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GCDFP-5-negative tumor cells. GCDFP-5-negative tumor cells of immunohistochemical staining (×100) cells.
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Figure 5: GCDFP-5-negative tumor cells. GCDFP-5-negative tumor cells of immunohistochemical staining (×100) cells.

Mentions: A 65-year-old Japanese woman had undergone standard mastectomy 6 years earlier, and had been administered postoperative chemotherapy on the basis of the biological properties of the drug, namely, t2n1, ER(-), and PgR(-). While the clinical course was being monitored, periodic, thoracic CT examination revealed a pulmonary mass shadow measuring 1.2 cm in diameter in the right S10 (Figure 1). This lesion had not been seen on the CT performed in the previous year. The possibility of primary lung cancer could not be ruled out based only on the CT finding, therefore, VATS resection was performed. It was not possible to determine by intraoperative rapid pathological diagnosis whether the lesion represented a primary lung cancer or a metastatic tumor, and the surgery was completed. Immunohistochemical staining of the resected specimen showed a cytokeratin (CK) profile of CK7(+) and CK20(-), characteristic of pulmonary adenocarcinoma, while the tumor tissue was also positive for thyroid transcription factor (TTF)-1, a lung cancer marker, and negative for gross cystic disease fluid protein (GCDFP)-15, a breast cancer marker. The tumor was thus diagnosed as a primary lung cancer (Figure 2, 3, 4 and 5). Three weeks later, right upper lobectomy and mediastinal lymph node resection were performed. The final diagnosis in the tumor was moderately differentiated adenocarcinoma, p-T1N0M0. No adjuvant chemotherapy was administered, and the patient remains alive with no evidence of recurrence, as of this writing.


Role of treatment for solitary pulmonary nodule in breast cancer patients.

Kitada M, Sato K, Matsuda Y, Hayashi S, Miyokawa N, Sasajima T - World J Surg Oncol (2011)

GCDFP-5-negative tumor cells. GCDFP-5-negative tumor cells of immunohistochemical staining (×100) cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198949&req=5

Figure 5: GCDFP-5-negative tumor cells. GCDFP-5-negative tumor cells of immunohistochemical staining (×100) cells.
Mentions: A 65-year-old Japanese woman had undergone standard mastectomy 6 years earlier, and had been administered postoperative chemotherapy on the basis of the biological properties of the drug, namely, t2n1, ER(-), and PgR(-). While the clinical course was being monitored, periodic, thoracic CT examination revealed a pulmonary mass shadow measuring 1.2 cm in diameter in the right S10 (Figure 1). This lesion had not been seen on the CT performed in the previous year. The possibility of primary lung cancer could not be ruled out based only on the CT finding, therefore, VATS resection was performed. It was not possible to determine by intraoperative rapid pathological diagnosis whether the lesion represented a primary lung cancer or a metastatic tumor, and the surgery was completed. Immunohistochemical staining of the resected specimen showed a cytokeratin (CK) profile of CK7(+) and CK20(-), characteristic of pulmonary adenocarcinoma, while the tumor tissue was also positive for thyroid transcription factor (TTF)-1, a lung cancer marker, and negative for gross cystic disease fluid protein (GCDFP)-15, a breast cancer marker. The tumor was thus diagnosed as a primary lung cancer (Figure 2, 3, 4 and 5). Three weeks later, right upper lobectomy and mediastinal lymph node resection were performed. The final diagnosis in the tumor was moderately differentiated adenocarcinoma, p-T1N0M0. No adjuvant chemotherapy was administered, and the patient remains alive with no evidence of recurrence, as of this writing.

Bottom Line: In 14 of these patients, video-assisted thoracoscopic surgery was performed to remove a SPN.The tumor grading based on pathological diagnosis was T1N0M0, p-Stage 1A in all 3 patients.The prognosis was good in the breast cancer patients in whom the metastatic lung tumor was a SPN.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1 Asahikawa Hokkaido 078-8510, Japan. k1111@asahikawa-med.ac.jp

ABSTRACT

Background: Metastatic pulmonary tumors secondary to breast cancer detected either before or after surgery are predominantly multiple and bilateral. However, in cases detected to have a solitary pulmonary nodule (SPN), determining whether the lesion represents a primary cancer, metastasis, or a benign pulmonary lesion can be difficult.

Materials and methods: Between January 2000 and December 2009, we performed breast cancer surgery on 1,226 patients, of which 49 cases (3.9%) were detected to have pulmonary lesions before or after the surgery. In 14 of these patients, video-assisted thoracoscopic surgery was performed to remove a SPN.

Result: Pathological examination of the resected specimens in these 14 cases revealed metastatic pulmonary tumor in 8 cases, primary lung cancer in 3 cases, and benign disease in 3 cases. While lobectomy was performed in one of these patients with metastatic pulmonary tumor, the remaining 7 underwent partial resection of the lung. The primary lung cancer was an adenocarcinoma in all 3 patients, and lobectomy plus mediastinal lymph node dissection was performed in these patients. The tumor grading based on pathological diagnosis was T1N0M0, p-Stage 1A in all 3 patients. The prognosis was good in the breast cancer patients in whom the metastatic lung tumor was a SPN.

Conclusion: Evaluating the immunohistochemical cytokeratin profile and levels of the TTF-1 and GCDFP-15 of the lesion was useful when distinguishing between pulmonary cancer and metastatic pulmonary tumor. In addition, some patients exhibited changes in the biological properties of the metastatic tumor, and delete tumor resection by video-assisted thoracoscopic surgery can be useful for deciding the drug treatment strategy in some cases.

Show MeSH
Related in: MedlinePlus