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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

In both of these cases, benign breast ductal cells are immunoreactive to estrogen receptor (left) and nonreactive to metastatic colonic glands (right) (200x magnification).
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fig9: In both of these cases, benign breast ductal cells are immunoreactive to estrogen receptor (left) and nonreactive to metastatic colonic glands (right) (200x magnification).

Mentions: Further confirmation of the above morphologic findings by immunohistochemical (IHC) staining is always recommended to establish an accurate final diagnosis. Cytokeratin 7 (CK 7) and cytokeratin 20 (CK 20) are the most widely used initial IHC panel [1, 5, 6, 12]. Additionally, positive immunostaining for CDX2 is a highly specific and sensitive marker for colon carcinoma [2, 11]. Most of the primary ductal adenocarcinomas of breast are immunoreactive to cytokeratin 7 (CK 7 (+)) and nonreactive to cytokeratin 20 (CK 20 (−)). Most colorectal carcinomas, unlike ductal adenocarcinoma of the breast, are positive for CK 20 (CK 20 (+)) (Figure 7) and negative for CK 7 (CK 7 (−)) [1, 6, 12]. Additionally, source-specific antibodies can be used to strengthen a diagnosis of colorectal origin, including positive CEA and CDX2 (Figure 8) and negative hormone receptor studies (estrogen receptor, progesterone receptor, and Her-2/Neu) as well, to rule out primary breast origin [12]. In these two cases, both the patients were positive for CXD2 and CK 20 and negative for CK 7, ER, and PR (Figure 9). This is consistent with an adenocarcinoma of colorectal origin and can be used to firmly establish a diagnosis.


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)

In both of these cases, benign breast ductal cells are immunoreactive to estrogen receptor (left) and nonreactive to metastatic colonic glands (right) (200x magnification).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig9: In both of these cases, benign breast ductal cells are immunoreactive to estrogen receptor (left) and nonreactive to metastatic colonic glands (right) (200x magnification).
Mentions: Further confirmation of the above morphologic findings by immunohistochemical (IHC) staining is always recommended to establish an accurate final diagnosis. Cytokeratin 7 (CK 7) and cytokeratin 20 (CK 20) are the most widely used initial IHC panel [1, 5, 6, 12]. Additionally, positive immunostaining for CDX2 is a highly specific and sensitive marker for colon carcinoma [2, 11]. Most of the primary ductal adenocarcinomas of breast are immunoreactive to cytokeratin 7 (CK 7 (+)) and nonreactive to cytokeratin 20 (CK 20 (−)). Most colorectal carcinomas, unlike ductal adenocarcinoma of the breast, are positive for CK 20 (CK 20 (+)) (Figure 7) and negative for CK 7 (CK 7 (−)) [1, 6, 12]. Additionally, source-specific antibodies can be used to strengthen a diagnosis of colorectal origin, including positive CEA and CDX2 (Figure 8) and negative hormone receptor studies (estrogen receptor, progesterone receptor, and Her-2/Neu) as well, to rule out primary breast origin [12]. In these two cases, both the patients were positive for CXD2 and CK 20 and negative for CK 7, ER, and PR (Figure 9). This is consistent with an adenocarcinoma of colorectal origin and can be used to firmly establish a diagnosis.

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