Breast cancer or metastasis? An unusual case of metastatic malignant pleural mesothelioma to the breast

Our plain-English summary of Breast cancer or metastasis? An unusual case of metastatic malignant pleural mesothelioma to the breast, by M. Framarino-dei-Malatesta, P. Sammartino, M. Derme, et al (World Journal of Surgical Oncology, 2015).

The study

• Authors: M. Framarino-dei-Malatesta, P. Sammartino, M. Derme, I. Iannini, G. Masselli, I. Pecorella
• Journal: World Journal of Surgical Oncology
• Published: 2015;13:79
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Metastases to the breast from extramammary malignancies are very rare, and ruling out the diagnosis of primary breast tumor is important in order to decide on clinical management and predict prognosis.

Case Presentation: Clinical examination revealed in a 49-year-old hairdresser a 3-cm hard lump adherent to the underlying layers in the right breast. Trucut biopsy was performed. Histology showed a solid proliferation of medium-sized neoplastic polygonal cells. Immunohistochemical analysis showed tumor cells diffusely positive for cytokeratin 8/18 and calretinin and focally positive for cytokeratin 5/6 and Wilms' tumor 1, e-cadherin, and human bone marrow endothelial-1. Estrogen receptors and progesterone receptors were negative. The final diagnosis was metastatic epithelioid malignant pleural mesothelioma.

Conclusions: Immunohistochemistry is an important tool for a conclusive diagnosis of malignant pleural mesothelioma. Owing to the degree of histological and immunohistochemical overlap, a high level of clinical suspicion is essential in order to avoid unnecessary mutilating surgery.

In plain English

This is a case report about one woman, from doctors in Rome, Italy. A 49-year-old hairdresser was referred to the authors' breast unit for suspected right breast cancer, and examination found a 3-cm hard lump in the right breast. A needle biopsy showed solid tumor tissue with no breast tissue. Staining tests on the tumor cells were positive for calretinin, cytokeratin 8/18 and other markers used to identify mesothelioma, and negative for estrogen and progesterone receptors. The final diagnosis was metastatic epithelioid malignant pleural mesothelioma: a cancer of the lining of the chest that had spread to the breast. A chest CT scan showed a 6-cm growth in the right parietal pleura. The breast lump was the first sign of the disease. When asked further, the patient reported daily professional use of asbestos-containing handheld hair dryers. She refused conventional cancer treatment and was alive after 9 months. The authors concluded that, because these tumors and breast cancer can look alike, a high level of clinical suspicion is essential to avoid unnecessary mutilating surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 49-year-old woman, a hairdresser, referred to a breast unit at Umberto I Hospital, Sapienza University of Rome, Italy, for suspected right breast cancer
• Exposure: Patient-reported daily professional use of asbestos-containing handheld hair dryers. No fiber type or dose is given.
• Main results:
  • Examination found a 3-cm hard lump in the right breast. Ultrasound showed a solid mass of 3 by 2.5 cm.
  • The biopsy showed no breast tissue. Tumor cells were diffusely positive for cytokeratin 8/18 and calretinin, and focally positive for CK 5/6, WT1, e-cadherin and HBME-1.
  • The tumor was negative for estrogen and progesterone receptors. It was also negative for Ber-EP4, thrombomodulin and CEA.
  • The final diagnosis was metastatic epithelioid malignant pleural mesothelioma.
  • Chest CT showed a 6-cm growth in the right parietal pleura and a 3-cm lump near the right axilla.
  • The breast lump was the first sign of the mesothelioma in this patient.
  • The patient refused conventional treatment in favor of alternative therapies and was alive after 9 months.
• The authors' conclusion: The authors concluded that, because mesothelioma and breast cancer overlap in their appearance under the microscope and on staining, a high level of clinical suspicion is essential to avoid unnecessary mutilating surgery. They also concluded that a large panel of stains is needed, and that CK 8/18, CK 5/6 and WT1 formed a useful panel, particularly together with negative ER and PR results.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Prognosis, Biopsy, Histology, Calretinin, Cytokeratin 5/6, Epithelioid.

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• Evaluation of androgen receptor and GATA binding protein 3 as immunohistochemical markers in the diagnosis of metastatic breast carcinoma to the lung — Y. Hattori, A. Yoshida, et al. (2015)
• Breast Metastasis from Malignant Pleural Mesothelioma: A Rare Challenging Entity — A. Catino, D. La Forgia, et al. (2018)
• GATA-3 and FOXA1 expression is useful to differentiate breast carcinoma from other carcinomas — D.G. Davis, M.T. Siddiqui, et al. (2016)
• Diagnostic utility of immunohistochemistry in distinguishing between epithelioid pleural mesotheliomas and breast carcinomas: a comparative study — N.G. Ordóñez, A.A. Sahin (2014)
• Expression of calretinin by breast carcinoma and the potential for misdiagnosis of mesothelioma — G. Powell, H. Roche, et al. (2011)

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