Breast metastasis from small cell lung carcinoma

Abstract

Breast metastases from extramammary neoplasms are very rare. We presented a 66 year-old female with metastasis of small cell lung carcinoma to the breast. She presented with consolidation over the left upper lobe of her lung undetermined after endobronchial or video-assisted thoracoscopic surgery (VATS) biopsy, and this was treated effectively after antibiotic therapy at initial stage. The left breast lumps were noted 4 months later, and she underwent a modified radical mastectomy under the impression of primary breast carcinoma. However, the subsequent chest imaging revealed re-growing mass over the left mediastinum and hilum, and cells with the same morphological and staining features were found from specimens of transbronchial brushing and biopsy. An accurate diagnosis to distinguish a primary breast carcinoma from metastatic one is very important because the therapeutic planning and the outcome between them are different.

Fig. 1

(a) Chest roentgenogram revealed opacified shadow over the left upper lung field; (b) Chest computed tomography showed that this lesion was composed of pulmonary parenchymal consolidation and a suspected mass lesion over the central hilar area

Fig. 1

(a) Chest roentgenogram revealed opacified shadow over the left upper lung field; (b) Chest computed tomography showed that this lesion was composed of pulmonary parenchymal consolidation and a suspected mass lesion over the central hilar area

Fig. 2

(a) Compared with Fig.1a, the shadow regressed 1 month after treatment with antibiotics; (b) The mass shadow re-grew 4 months after treatment

Fig. 2

(a) Compared with Fig.1a, the shadow regressed 1 month after treatment with antibiotics; (b) The mass shadow re-grew 4 months after treatment

Fig. 3

Two breast masses, with 3 cm (a) and 0.8 cm (b) in diameter over the 4 o’clock direction, 4.5 cm from the nipple and 12 o’clock direction, 4 cm from the nipple sites of the left breast being noted on breast ultrasound imaging

Fig. 3

Two breast masses, with 3 cm (a) and 0.8 cm (b) in diameter over the 4 o’clock direction, 4.5 cm from the nipple and 12 o’clock direction, 4 cm from the nipple sites of the left breast being noted on breast ultrasound imaging

Fig. 4

Microscopically, the sections of breast tumor lesions reveal small hyperchromatic cells with high nucleus-to-cytoplasm (N/C) ratio. Tumor necrosis, emboli and vascular invasion are noted frequently (H & E stain)

Fig. 5

The breast tumor cells are positively stained for synaptophysin (a) and chromogranin (b)

Fig. 5

The breast tumor cells are positively stained for synaptophysin (a) and chromogranin (b)

Fig. 6

Microscopically, the lung mass is proved as small cell carcinoma with similar morphological and staining patterns as those of the breast mass. (a) H & E stain; (b) Focal positive for synaptophysin staining

Fig. 6

Microscopically, the lung mass is proved as small cell carcinoma with similar morphological and staining patterns as those of the breast mass. (a) H & E stain; (b) Focal positive for synaptophysin staining