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Case Reports
. 2022 Jul 8:38:101699.
doi: 10.1016/j.rmcr.2022.101699. eCollection 2022.

Pulmonary metastasis of matrix-producing carcinoma mimicking small cell lung cancer

Azusa Nakamura  1 , Mikito Suzuki  1 , Reiko Shimizu  1 , Toshiyuki Shima  1 , Masahiko Harada  1 , Tsunekazu Hishima  2 , Hirotoshi Horio  1
Affiliations
Case Reports

Pulmonary metastasis of matrix-producing carcinoma mimicking small cell lung cancer

Azusa Nakamura et al. Respir Med Case Rep. .

Abstract

Matrix-producing carcinoma (MPC) of the breast is an extremely rare subtype of invasive breast cancer. MPC is characterized by the production of a cartilaginous or osseous matrix without spindle cells. It is an aggressive carcinoma, often presenting as triple-negative breast cancer. MPC frequently metastasizes to the lungs; however, it rarely reoccurs as a solitary pulmonary metastasis. We report a case of a 77-year-old non-smoking woman with a solitary pulmonary metastasis of MPC, which mimicked small cell lung cancer (SCLC). Initially, the pulmonary metastasis was misdiagnosed as SCLC based on its morphological and immunochemical features, including focal positivity for CD56 and thyroid transcription factor-1. Although the portion of the chondromyxoid matrix of the primary site was not small, that of the metastatic site was small. A focal cartilaginous matrix deposition of pulmonary metastasis from MPC could make it difficult to differentiate from SCLC. We should acknowledge that the portion of chondromyxoid matrix may differ between primary and distant metastatic sites in MPC.

Keywords: Breast cancer; CT, computed tomography; MPC, matrix-producing carcinoma; Matrix-producing carcinoma; Pulmonary metastasis; SCLC, small cell lung cancer; Small cell lung cancer; TTF-1, thyroid transcription factor-1.

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Figures

Fig. 1
Fig. 1
Preoperative imaging findings. (A) Computed tomography scan showing a 1.8 cm solitary solid pulmonary nodule in the left upper lobe of the lung. (B) Positron emission tomography-computed tomography. A high fluorodeoxyglucose uptake with a maximum standardized uptake value of 11.5 was revealed.
Fig. 2
Fig. 2
Pathological findings. (A) The low-power view of the pulmonary nodule shows that the tumor comprised a necrotic center (hematoxylin-eosin staining). (B) The high-power view of the pulmonary nodule. Sheets of small round cells had prominent nuclear chromatin with molding and palisading formation (hematoxylin-eosin staining). (C) The low-power view of the initial breast cancer. Prominent central necrosis adjacent to the periphery of viable tumor, resembling a pulmonary nodule (hematoxylin-eosin staining). (D) The high-power view of the initial breast cancer. Sheets of small round cells were present with chondromyxoid matrix in the central necrotic area (E), indicating MPC of the breast (hematoxylin-eosin staining). (F) The high-power view of the pulmonary nodule. Focal chondromyxoid-like matrix is seen, indicating metastasis from MPC (hematoxylin-eosin staining). MPC: matrix-producing carcinoma.
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