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Occult Breast Lobular Carcinoma with Numerous Circulating Tumor Cells in Peripheral Blood.

Ogura K, Amano M, Matsumoto T, Sakaguchi A, Kosaka T, Kitabatake T, Kojima K - Case Rep Pathol (2015)

Bottom Line: We experienced a very rare case of occult breast lobular carcinoma with numerous circulating tumor cells in peripheral blood.The diagnosis was very difficult because there were no symptoms of breast cancer and the preceding chief complaints such as general fatigue and weight loss or abnormality of peripheral blood findings were suggestive of a hematological disease.We could make a correct diagnosis of this case by checking the findings of complete blood count and bone marrow biopsy at the same time using immunohistochemistry.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan.

ABSTRACT
We experienced a very rare case of occult breast lobular carcinoma with numerous circulating tumor cells in peripheral blood. The diagnosis was very difficult because there were no symptoms of breast cancer and the preceding chief complaints such as general fatigue and weight loss or abnormality of peripheral blood findings were suggestive of a hematological disease. We could make a correct diagnosis of this case by checking the findings of complete blood count and bone marrow biopsy at the same time using immunohistochemistry.

No MeSH data available.


Related in: MedlinePlus

(a) Mammography. There was no lesion in either breast. (b) Enhanced MRI. There was also no lesion in either breast.
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fig3: (a) Mammography. There was no lesion in either breast. (b) Enhanced MRI. There was also no lesion in either breast.

Mentions: Her physician performed a bone marrow puncture. The bone marrow specimen showed so-called “packed bone marrow” and fibrosis was also shown, so aspiration failed (so-called “dry tap”). In the biopsy specimen, numerous small round cells that were the same as the cells in the peripheral blood had grown with proliferation of reticular fibers (Figures 2(a) and 2(b)). We continued histological investigation using immunohistochemistry. These tumor cells were negative for LCA but positive for AE1/AE3. Furthermore, tumor cells were also positive for GCDFP15, ER, and (Figure 2(c)) PgR but negative for E-cadherin. On the basis of the result of immunohistochemistry, we diagnosed the bone marrow lesion as metastatic lobular carcinoma of the breast. Subsequently, the patient underwent detailed examination concentrating on imaging study. However, no lesion in either breast was identified by mammography (Figure 3(a)), ultrasonography, and even contrast-enhanced CT or MRI (Figure 3(b)). Enhanced CT images showed swelling of left axillary, right internal mammary, and perigastric lymph nodes and diffuse thickening of gastric wall like “Bormann 4 tumor” (Figure 4). T1-weighted MRI revealed generalized bone marrow metastasis. Fatty bone marrow was diffusely occupied by low-intensity lesion (Figure 5). Furthermore, bone scintigraphy also revealed generalized osseous metastasis by so-called “beautiful bone sign.” Biopsies from an enlarged left axillary lymph node and from gastric mucosa were performed, resulting in the finding of metastatic lobular carcinoma that we confirmed by immunohistochemistry including ER, PgR, and GCDFP15 (Figures 6 and 7). We summarized the immunohistochemical findings of bone marrow, axillary lymph node, and gastric biopsy specimens in Table 2. Carcinoma from accessory breast tissue in axilla was also ruled out.


Occult Breast Lobular Carcinoma with Numerous Circulating Tumor Cells in Peripheral Blood.

Ogura K, Amano M, Matsumoto T, Sakaguchi A, Kosaka T, Kitabatake T, Kojima K - Case Rep Pathol (2015)

(a) Mammography. There was no lesion in either breast. (b) Enhanced MRI. There was also no lesion in either breast.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4496473&req=5

fig3: (a) Mammography. There was no lesion in either breast. (b) Enhanced MRI. There was also no lesion in either breast.
Mentions: Her physician performed a bone marrow puncture. The bone marrow specimen showed so-called “packed bone marrow” and fibrosis was also shown, so aspiration failed (so-called “dry tap”). In the biopsy specimen, numerous small round cells that were the same as the cells in the peripheral blood had grown with proliferation of reticular fibers (Figures 2(a) and 2(b)). We continued histological investigation using immunohistochemistry. These tumor cells were negative for LCA but positive for AE1/AE3. Furthermore, tumor cells were also positive for GCDFP15, ER, and (Figure 2(c)) PgR but negative for E-cadherin. On the basis of the result of immunohistochemistry, we diagnosed the bone marrow lesion as metastatic lobular carcinoma of the breast. Subsequently, the patient underwent detailed examination concentrating on imaging study. However, no lesion in either breast was identified by mammography (Figure 3(a)), ultrasonography, and even contrast-enhanced CT or MRI (Figure 3(b)). Enhanced CT images showed swelling of left axillary, right internal mammary, and perigastric lymph nodes and diffuse thickening of gastric wall like “Bormann 4 tumor” (Figure 4). T1-weighted MRI revealed generalized bone marrow metastasis. Fatty bone marrow was diffusely occupied by low-intensity lesion (Figure 5). Furthermore, bone scintigraphy also revealed generalized osseous metastasis by so-called “beautiful bone sign.” Biopsies from an enlarged left axillary lymph node and from gastric mucosa were performed, resulting in the finding of metastatic lobular carcinoma that we confirmed by immunohistochemistry including ER, PgR, and GCDFP15 (Figures 6 and 7). We summarized the immunohistochemical findings of bone marrow, axillary lymph node, and gastric biopsy specimens in Table 2. Carcinoma from accessory breast tissue in axilla was also ruled out.

Bottom Line: We experienced a very rare case of occult breast lobular carcinoma with numerous circulating tumor cells in peripheral blood.The diagnosis was very difficult because there were no symptoms of breast cancer and the preceding chief complaints such as general fatigue and weight loss or abnormality of peripheral blood findings were suggestive of a hematological disease.We could make a correct diagnosis of this case by checking the findings of complete blood count and bone marrow biopsy at the same time using immunohistochemistry.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan.

ABSTRACT
We experienced a very rare case of occult breast lobular carcinoma with numerous circulating tumor cells in peripheral blood. The diagnosis was very difficult because there were no symptoms of breast cancer and the preceding chief complaints such as general fatigue and weight loss or abnormality of peripheral blood findings were suggestive of a hematological disease. We could make a correct diagnosis of this case by checking the findings of complete blood count and bone marrow biopsy at the same time using immunohistochemistry.

No MeSH data available.


Related in: MedlinePlus