A case report of breast cancer with extensive pulmonary lymphovascular tumor emboli

Abstract

We describe a patient with breast cancer who relapsed with an extensive pulmonary lymphovascular tumor embolism. A 38-year-old female, who previously received neoadjuvant chemotherapy and curative resection of breast cancer, underwent adjuvant chemotherapy and was referred to the emergency room because of sudden-onset pleuritic chest pain lasting for 10 days. Despite a trial of empirical antibiotics, the chest pain and the extent of consolidative lung lesion on chest radiographs rapidly aggravated. We performed an open lung biopsy to confirm the etiology. The histopathological review revealed a hemorrhagic infarction caused by lymphovascular tumor emboli from a metastatic breast carcinoma. Palliative first-line chemotherapy was administered, consisting of ixabepilone and capecitabine, and the lung lesion improved markedly.

Keywords: Breast neoplasms; Ixabepilone; Tumor embolism.

Figure 1

(A) Chest PA at symptom presentation (10 days before emergency room visit). No remarkable findings are observed. (B) Chest PA at the emergency room. Patchy consolidative lesion on the right upper lobe (RUL) is shown (arrow). (C) After 1 week of empirical antibiotics for community acquired pneumonia, RUL consolidation had not improved, and consolidation near the interlobar fissure and hilum increased in extent (arrow and arrowhead). (D) After the open lung biopsy and just before palliative chemotherapy, the RUL and the right lower lobe (RLL) consolidative lesion (arrow) and ground glass opacity further increased. (E) After 17 months of palliative chemotherapy, consolidative lesions in RUL and RLL decreased markedly.

Figure 2

(A, B) Chest computed tomography (CT) scan at the emergency room. Patchy consolidative mass-like lesion in the right upper lobe (RUL) (arrow) with focal ground glass opacity (GGO) (arrowhead). (C, D) After 1 week of empirical antibiotics for community acquired pneumonia, RUL consolidation and consolidation near the interlobar fissure and hilum increased in extent (arrows), and GGO of the RUL increased in extent (arrowhead).

Figure 3

Microscopic appearance of the lung wedge resection specimen. Arrows show hemorrhagic infarction area. Arrowheads and asterisk indicate intravascular and endolymphatic tumor emboli, respectively.

Figure 4

(A) Arrowhead and asterisk indicate intravascular and endolymphatic tumor emboli, respectively. (B, C) Figures show magnified image of lymphovascular tumor emboli.