Korean J Radiol.  2012 Apr;13(2):249-253. 10.3348/kjr.2012.13.2.249.

Micropapillary Lung Cancer with Breast Metastasis Simulating Primary Breast Cancer due to Architectural Distortion on Images

• Ko K
• Ro JY
• Hong EK
• Lee S

• KMID: 1245392
• DOI: http://doi.org/10.3348/kjr.2012.13.2.249

Abstract

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.

Keyword

Metastasis; Breast images; Lung cancer; Micropapillary carcinoma

MeSH Terms

Adenocarcinoma/drug therapy/*secondary
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Biopsy, Needle
Bone Neoplasms/secondary
Breast Neoplasms/drug therapy/*secondary
Diagnosis, Differential
Female
Humans
Lung Neoplasms/*pathology
Lymphatic Metastasis
Mammography
Middle Aged
Neoplasm Staging
Tomography, X-Ray Computed
Ultrasonography, Mammary

Figure

• 

  Fig. 1 Images and pathologic findings in 47-year-old woman with primary lung cancer. A. Outside chest CT shows round mass with internal necrosis in right middle lobe (arrow), with right pleural effusion. B. Primary lung cancer shows adenocarcinoma with papillary and micropapillary carcinoma (arrow; Hematoxylin and Eosin staining, × 100). TTF-1 stain reveals nuclear positivity (inset, TTF-1 immunostaining, × 200). C. Spot compression view of right breast shows focal architectural distortion (arrow) in right lower inner quadrant without evidence of microcalcifications or discrete mass. Metallic marker is attached to area of palpable site. D. Follow-up chest CT shows irregular enhancing lesion of right breast in lower inner quadrant (arrow). E. Breast US demonstrates 1 cm sized ill-defined irregular shaped isoechoic lesion (arrows) with focal infiltration at 4 o'clock position in right breast. F. Breast biopsy shows micropapillary carcinoma with small tumor cell nests in empty lacunar spaces and desmoplastic reaction in stroma (Hematoxylin and Eosin staining, × 100). TTF-1 stain reveals nuclear positivity, supporting metastasis from lung (TTF-1 immunostaining, × 100).

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