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Lung Cancer |

Delayed Presentation of Breast Cancer Metastatic to Solitary Fibrous Tumor of the Lung With Synchronous Contralateral Primary Non-small Cell Lung Cancer: A Case Report

Frank Velez-Cubian, MD; Robert Gabordi, MD; Prudence Smith, MD; Shohreh Dickinson, MD; Carla Moodie, PA-C; Joseph Garrett, ARNP-C; Eric Toloza, MD
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Moffitt Cancer Center, Tampa, FL


Chest. 2014;145(3_MeetingAbstracts):295A. doi:10.1378/chest.1836681
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Abstract

SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: A solitary fibrous tumor (SFT) is a rare pleural neoplasm, and tumor-to-tumor metastases are unusual phenomena.

CASE PRESENTATION: A 64-year-old woman, with history of positron-emission tomography (PET)-negative invasive ductal carcinoma, Nottingham grade I, ER(+)/PR(+)/HER2(-), treated 6 years previously with cyclophosphamide and doxorubicin, then weekly paclitaxel. Upon progression, she underwent right simple and left modified radical mastectomies, with 9 of 11 left axillary lymph nodes involved by metastatic carcinoma, T1cN2aM0, followed by maintenance letrozole, which was stopped 6 months previously. She recently presented with increasing dyspnea, and imaging studies revealed a 2.9-cm, PET-positive (SUV 7.6) right lung mass and a 2.8-cm, PET-negative left lung mass. She underwent video-assisted thoracoscopic left lower lobe wedge resection, immediately followed by robotic-assisted video-thoracoscopic right upper lobectomy with mediastinal lymph node dissection. Operative (skin-to-skin) time was 267 min; estimated blood loss was 500 mL. She had no postoperative complications. The left chest tube was removed on postoperative day (POD)#1; the right chest tube was removed on POD#4. She was discharged home on POD#4. Pathology revealed a 1.4-cm x 1.3-cm x 0.8-cm right upper lobe moderately-differentiated adenocarcinoma with peripheral bronchioloalveolar pattern, T1aN0M0, stage 1A (negative resection margins) as well as a 4-cm x 3.5-cm x 1.8-cm left lower lobe pedunculated focally cystic pleural SFT containing metastatic breast ductal carcinoma, ER(+)/PR(+)/HER2(-), extending to within 0.5 mm of SFT surface and within vessels of the pseudocapsule (negative resection margins). She was placed on adjuvant fulvestrant and exemestane.

DISCUSSION: SFTs have been described as recipients for tumor-to-tumor metastases in only 5 other cases, 4 of which were synchronous with the primary donor tumor. SFTs are firm, smooth, lobulated, spindle-cell masses surrounded by capsules exhibiting rich vascularity, a characteristic shared with renal cell carcinoma, making them more suitable for harboring metastasis.

CONCLUSIONS: We present an unusual case of tumor-to-tumor metastasis involving (PET)-negative breast cancer as donor to a recipient SFT 6 years after treatment for primary breast cancer and synchronous with contralateral primary lung cancer.

Reference #1: Petraki et al, International Journal of Surgical Pathology 11(2):127-135, 2003

DISCLOSURE: Eric Toloza: Other: Honoraria from Intuitive Surgical Inc. for proctoring & observation site The following authors have nothing to disclose: Frank Velez-Cubian, Robert Gabordi, Prudence Smith, Shohreh Dickinson, Carla Moodie, Joseph Garrett

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