Breast metastasis as the initial presentation of malignant pleural mesothelioma

Our plain-English summary of Breast metastasis as the initial presentation of malignant pleural mesothelioma, by L. Korša, A. Lukač, L. Kovačević, et al (The Breast Journal, 2020).

The study

• Authors: L. Korša, A. Lukač, L. Kovačević, I. Bilić, M. Prutki, Z. Marušić
• Journal: The Breast Journal
• Published: 2020;26(10):2063-2064
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Metastatic involvement of the breast is far less common than primary breast carcinoma, comprising 0.5%-6.6% of all breast malignancies. Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor with higher incidence among men, particularly smokers, strongly associated with asbestos exposure. The epithelioid type of MPM can represent a diagnostic pitfall in this setting, as it shows similar histologic features to primary breast carcinoma as well as other metastatic epithelioid malignancies. We report a rare case of breast metastasis of malignant pleural mesothelioma in a 61-year-old female.

© 2020 Wiley Periodicals LLC.

In plain English

This article is a case report about one patient, from University Hospital Centre Zagreb, Croatia. A 61-year-old woman had a newly found lump in her left breast and enlarged lymph nodes in her left armpit. This was 17 years after she was diagnosed with invasive breast cancer in the other breast, which had been treated. She also had an occasional dry cough and shortness of breath. Ultrasound showed a 1.1 by 0.6 cm mass in the breast. A chest X-ray showed a mass at the root of the left lung and fluid around it. A needle biopsy found a lymph node inside the breast that was invaded by abnormal cells. The authors judged that the cells' appearance and special stains showed epithelioid malignant pleural mesothelioma that had spread to the breast. A CT scan showed large masses on the lining of the lower left lung, also involving the diaphragm. The authors state that the patient had no history of asbestos exposure. Planned surgery had not yet been done because of the COVID-19 pandemic. The authors concluded that, although this spread is rare, doctors should suspect mesothelioma in breast tumors with features resembling it.

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 (single patient)
• Who was studied: One 61-year-old woman with a newly discovered left breast tumor and enlarged left axillary lymph nodes. She had been diagnosed 17 years earlier with invasive breast carcinoma in the other breast, which was treated by mastectomy, radiation and chemotherapy. Her history also included papillary thyroid carcinoma and a traffic accident with chest contusion. She had occasional dry cough and shortness of breath. The authors are based at University Hospital Centre Zagreb, Croatia. No dates are given.
• Exposure: The authors state that the patient had no history of asbestos exposure. No fiber type, job or product is described.
• Main results:
  • Breast ultrasound showed an oval hypoechoic mass measuring 1.1 by 0.6 cm in the left lower lateral quadrant.
  • Chest radiogram showed a left pulmonary hilar mass and left pleural effusion.
  • Core needle biopsy of the breast mass showed tissue consistent with an intramammary lymph node, infiltrated by papillary and solid clusters of atypical epithelioid cells.
  • The tumor cells were diffusely positive for calretinin, WT1, CK 5/6 and CK7. They were negative for estrogen receptor, progesterone receptor, GATA3, mammaglobin and other markers. The authors considered the histologic and immunohistochemical findings diagnostic of breast metastasis by epithelioid malignant pleural mesothelioma.
  • CT scan revealed large, pleural-based masses occupying the left lung base with involvement of the diaphragm.
  • Scheduled video-assisted thoracoscopic surgery (VATS) had not yet been performed because of the COVID-19 pandemic.
• The authors' conclusion: The authors concluded that, despite the rarity of metastatic malignant pleural mesothelioma, a high index of suspicion should be exerted in breast tumors showing papillary architecture and cell features reminiscent of it. They added that the correct diagnosis can be readily confirmed by immunohistochemistry.

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, Carcinoma, Asbestos Exposure, Epithelioid.

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