Metastatic disease to the breast: the Washington University experience

Abstract

Background: Metastases to the breast occur rarely, but may be increasing in incidence as patients live longer with malignant diseases. The aim of this study is to characterize metastatic disease to the breast and to describe the management and prognosis of patients who present with this diagnosis.

Methods: A retrospective review of our institution's pathology and breast cancer databases was performed in order to identify patients with breast malignancies that were not of primary breast origin. Chart review provided additional information about the patients' primary malignancies and course of illness.

Results: Between 1991 and 2006, eighteen patients with metastatic disease to the breast of non-hematologic origin were identified and all had charts available for review. Among the 18 patients with disease metastatic to the breast, tissues of origin included 3 ovarian, 6 melanoma, 3 medullary thyroid, 3 pulmonary neuroendocrine, 1 pulmonary small cell, 1 oral squamous cell, and 1 renal cell. Overall mean survival after diagnosis of metastatic disease to the breast was 22.4 months. Treatment of metastases varied and included combinations of observation, surgery, radiation, and chemotherapy. Five patients (27.8%) required a change in management of their breast disease for local control.

Conclusion: Due to the variable course of patients with metastatic disease, a multi-disciplinary approach is necessary for each patient with disease metastatic to the breast to determine optimal treatment. Based on our review, many patients survive for long periods of time and local treatment of metastases to the breast may be beneficial in these patients to prevent local complications.

Figure 1

Left and right craniocaudal mammogram views from a 35 year-old patient who presented with bilateral palpable breast masses. She was found to have metastatic disease to her breast from a lung neuroendocrine carcinoma.

Figure 2

Left and right mediolateral oblique views from a 35 year-old patient who presented with bilateral palpable breast masses. She was found to have metastatic disease to her breast from a lung neuroendocrine carcinoma.

Figure 3

Right breast ultrasound from a 35 year-old patient with bilateral palpable breast masses. The ultrasound documented a 19 × 14 mm hypoechoic mass. She was found to have metastatic disease to her breast from a lung neuroendocrine carcinoma.

Figure 4

Left breast ultrasound from a 35 year-old patient with bilateral palpable breast masses. The ultrasound documented a 42 × 36 mm hypoechoic mass. She was found to have metastatic disease to her breast from a lung neuroendocrine carcinoma.

Figure 5

Histological sections from a 35 year-old patient with bilateral palpable breast masses. A representative hematoxylin and eosin section of the left breast mass core needle biopsy specimen is shown at 600 × magnification. The tumor is composed of diffuse sheets of small polygonal cells with nuclear molding, scant cytoplasm, brisk apoptotic rate, and numerous mitoses. Tumor cells were negative for estrogen receptor, progesterone receptor, and Her2neu (slides not shown).

Figure 6

Sections of the left breast mass core needle biopsy specimen shown in Figure 5 were positive for chromogranin A immunostaining.

Figure 7

Sections of the left breast mass core needle biopsy specimen shown in Figure 5 were positive for synaptophysin immunostaining. Identical histological features were seen on the contralateral breast core biopsy specimen. The immunostain results suggested a neuroendocrine carcinoma, rather than a primary breast adenocarcinoma. Staging exams confirmed a lung primary.