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Metastatic colonic adenocarcinoma in breast: report of two cases and review of the literature.

Kothadia JP, Arju R, Kaminski M, Ankireddypalli A, Duddempudi S, Chow J, Giashuddin S - Case Rep Oncol Med (2015)

Bottom Line: Here we present two rare cases, in which colonic adenocarcinomas were found to metastasize to the breast.By immunohistochemical staining, it was confirmed that the neoplastic components were immunoreactive to colonic markers and nonreactive to breast markers, thus further supporting the morphologic findings.It is extremely important to make this distinction between primary breast cancer and a metastatic process, in order to provide the most effective and appropriate treatment for the patient and to avoid any harmful or unnecessary surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, The Brooklyn Hospital Center, An Academic Affiliate of Icahn School of Medicine at Mount Sinai, 121 DeKalb Avenue, Brooklyn, NY 11201, USA.

ABSTRACT
Metastatic adenocarcinoma to the breast from an extramammary site is extremely rare. In the literature, the most current estimate is that extramammary metastases account for only 0.43% of all breast malignancies and that, of these extramammary sites, colon cancer metastases form a very small subset. Most commonly seen metastasis in breast is from a contralateral breast carcinoma, followed by metastasis from hematopoietic neoplasms, malignant melanoma, sarcoma, lung, prostate, and ovary and gastric neoplasms. Here we present two rare cases, in which colonic adenocarcinomas were found to metastasize to the breast. In both cases, core biopsies were obtained from the suspicious areas identified on mammogram. Histopathology revealed neoplastic proliferation of atypical glandular components within benign breast parenchyma which were morphologically consistent with metastatic adenocarcinoma. By immunohistochemical staining, it was confirmed that the neoplastic components were immunoreactive to colonic markers and nonreactive to breast markers, thus further supporting the morphologic findings. It is extremely important to make this distinction between primary breast cancer and a metastatic process, in order to provide the most effective and appropriate treatment for the patient and to avoid any harmful or unnecessary surgical procedures.

No MeSH data available.


Related in: MedlinePlus

Ultrasonography image of the right breast showing 1.4 cm × 1.2 cm irregularly shaped, speculated, hypoechoic lesion with central necrotic changes and high vascularity.
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fig3: Ultrasonography image of the right breast showing 1.4 cm × 1.2 cm irregularly shaped, speculated, hypoechoic lesion with central necrotic changes and high vascularity.

Mentions: A right breast ultrasound was performed at the same time and showed the palpable mass to be an irregularly shaped, spiculated, hypoechoic lesion with central necrotic changes and high vascularity (Figure 3). No lymph nodes were seen in the right axilla. The patient was sent for an ultrasound guided core biopsy of the lesion. Histopathologic examination of the core biopsy samples showed atypical glandular proliferation within benign appearing breast parenchyma. Cells in these atypical glands showed enlarged, hyperchromatic nuclei, prominent nucleoli with nuclear crowding and pseudostratification. There was no evidence of in situ ductal or lobular carcinoma noted in these biopsy samples. Atypical glands and a few benign breast ducts were associated with microcalcifications and scant, intraglandular necrotic debris. All these findings were morphologically consistent with a diagnosis of adenocarcinoma. Upon further work-up by immunohistochemical staining, the neoplastic glands were shown to be positive for CDX2 and CK 20 (focal), while being negative for CK 7, ER, PR, Mammaglobin, and GCDFP-15. Overall, the tumor was morphologically and immunophenotypically consistent with a metastatic adenocarcinoma of colorectal origin. The diagnosis was further confirmed by a series of discussions with the colorectal surgeon and medical oncologist who had treated the patient earlier. Given the patient's advanced metastatic disease and her poor functional status it was decided that chemotherapy would cause more harm than good. The patient was subsequently referred to a palliative care team and the patient decided to go for home hospice care.


Metastatic colonic adenocarcinoma in breast: report of two cases and review of the literature.

Kothadia JP, Arju R, Kaminski M, Ankireddypalli A, Duddempudi S, Chow J, Giashuddin S - Case Rep Oncol Med (2015)

Ultrasonography image of the right breast showing 1.4 cm × 1.2 cm irregularly shaped, speculated, hypoechoic lesion with central necrotic changes and high vascularity.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4390182&req=5

fig3: Ultrasonography image of the right breast showing 1.4 cm × 1.2 cm irregularly shaped, speculated, hypoechoic lesion with central necrotic changes and high vascularity.
Mentions: A right breast ultrasound was performed at the same time and showed the palpable mass to be an irregularly shaped, spiculated, hypoechoic lesion with central necrotic changes and high vascularity (Figure 3). No lymph nodes were seen in the right axilla. The patient was sent for an ultrasound guided core biopsy of the lesion. Histopathologic examination of the core biopsy samples showed atypical glandular proliferation within benign appearing breast parenchyma. Cells in these atypical glands showed enlarged, hyperchromatic nuclei, prominent nucleoli with nuclear crowding and pseudostratification. There was no evidence of in situ ductal or lobular carcinoma noted in these biopsy samples. Atypical glands and a few benign breast ducts were associated with microcalcifications and scant, intraglandular necrotic debris. All these findings were morphologically consistent with a diagnosis of adenocarcinoma. Upon further work-up by immunohistochemical staining, the neoplastic glands were shown to be positive for CDX2 and CK 20 (focal), while being negative for CK 7, ER, PR, Mammaglobin, and GCDFP-15. Overall, the tumor was morphologically and immunophenotypically consistent with a metastatic adenocarcinoma of colorectal origin. The diagnosis was further confirmed by a series of discussions with the colorectal surgeon and medical oncologist who had treated the patient earlier. Given the patient's advanced metastatic disease and her poor functional status it was decided that chemotherapy would cause more harm than good. The patient was subsequently referred to a palliative care team and the patient decided to go for home hospice care.

Bottom Line: Here we present two rare cases, in which colonic adenocarcinomas were found to metastasize to the breast.By immunohistochemical staining, it was confirmed that the neoplastic components were immunoreactive to colonic markers and nonreactive to breast markers, thus further supporting the morphologic findings.It is extremely important to make this distinction between primary breast cancer and a metastatic process, in order to provide the most effective and appropriate treatment for the patient and to avoid any harmful or unnecessary surgical procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, The Brooklyn Hospital Center, An Academic Affiliate of Icahn School of Medicine at Mount Sinai, 121 DeKalb Avenue, Brooklyn, NY 11201, USA.

ABSTRACT
Metastatic adenocarcinoma to the breast from an extramammary site is extremely rare. In the literature, the most current estimate is that extramammary metastases account for only 0.43% of all breast malignancies and that, of these extramammary sites, colon cancer metastases form a very small subset. Most commonly seen metastasis in breast is from a contralateral breast carcinoma, followed by metastasis from hematopoietic neoplasms, malignant melanoma, sarcoma, lung, prostate, and ovary and gastric neoplasms. Here we present two rare cases, in which colonic adenocarcinomas were found to metastasize to the breast. In both cases, core biopsies were obtained from the suspicious areas identified on mammogram. Histopathology revealed neoplastic proliferation of atypical glandular components within benign breast parenchyma which were morphologically consistent with metastatic adenocarcinoma. By immunohistochemical staining, it was confirmed that the neoplastic components were immunoreactive to colonic markers and nonreactive to breast markers, thus further supporting the morphologic findings. It is extremely important to make this distinction between primary breast cancer and a metastatic process, in order to provide the most effective and appropriate treatment for the patient and to avoid any harmful or unnecessary surgical procedures.

No MeSH data available.


Related in: MedlinePlus