SESSION TITLE: Lung Cancer Case Report Posters II
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Lung cancer is the leading cause of cancer-related mortality globally with a 5 year survival of only16%. Unfortunately, it is frequently diagnosed late when the patient presents with extrathoracic metastatic disease. Metastatic disease to the breast from extra-mammary malignancy is very rare with an incidence of 0.4-1.3% reported in the literature. We present a case of lung cancer with metastatic disease to the breast in a male patient.
CASE PRESENTATION: A 58 y/o male, prior 80 pack year smoker with a past history of COPD and stroke presented with a 4 month history of a lump in the left breast associated with localized tenderness under the left arm. There was no family history of breast cancer. On exam, his vital signs were remarkable only for a slightly elevated blood pressure. His lungs were clear and his examination with otherwise normal except for a 2 cm firm, non-tender mass in the left breast at the 12:30 position. No skin changes, nipple discharge, supraclavicular or axillary adenopathy was noted. Examination of the right breast was normal. Ultrasound confirmed a 1.8 cm mass in the superior aspect of the left breast. Core biopsy of the left breast was initially reported as invasive ductal carcinoma, grade 3 with ER, PR HER2/Neu negative staining. PET/CT showed a hypermetabolic lesion in the left breast with hypermetabolic hilar lymphadenopathy, as well as a small peripheral lung nodule and a small adrenal nodule. Bronchoscopy with endobronchial ultrasound (EBUS) for node sampling was performed showing malignancy. Further stains of the breast biopsy subsequently resulted in an amended report showing adenocarcinoma with glandular formation with negative mammoglobin and GCDFP but TTF-1 positivity consistent with lung adenocarcinoma.
DISCUSSION: Metastasis to the mammary gland should be considered in the differential diagnosis of breast carcinoma when typical characteristics are not present. However, distinction of primary breast cancer from metastatic disease can be difficult based on radiologic and histological evidence alone. It also requires a high index of suspicion and the use of immunohistochemistry as a crucial tool to establish the diagnosis.
CONCLUSIONS: Educational Case
Reference #1: 1- Lung adenocarcinoma metastasis to the male breast: a case report. Hachisuka A, Takahashi R, Nakagawa S, Takahashi H, Inoue Y, Akashi M, Ichiki M, Momosaki S, Kawahara A, Shirouzu K, Fujii T. Kurume Med J. 2015
DISCLOSURE: The following authors have nothing to disclose: Yousof Elgaried, James Perry, Nancy Munn, Mohamed Tashani, Emhemmid Karem, Doreen Griswold, Fuad Zeid
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