Breast or chest? A diagnostic conundrum

Our plain-English summary of Breast or chest? A diagnostic conundrum, by J.C. Lee, S. Banerjee, D.M. King (The British Journal of Radiology, 2005).

The study

• Authors: J.C. Lee, S. Banerjee, D.M. King
• Journal: The British Journal of Radiology
• Published: 2005;78(929):471-2
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This case report described a 60-year-old woman with a painless left breast swelling noticed 3 weeks earlier. Doctors felt a soft, lobulated 2 cm by 2 cm lump in the upper inner breast. A mammogram showed no mass. Ultrasound showed a well-defined mass lying beneath the chest muscle, with normal breast tissue above it. A chest X-ray showed fluid around the left lung (pleural effusion) and irregular thickening of its lining. A CT scan showed a mass growing into the front left chest wall, destroying the rib-cartilage junction, with a large effusion. A needle sample was inadequate, so a surgical biopsy of the chest wall mass was done, and tissue examination established malignant pleural mesothelioma. The authors noted that surgical removal of the pleura was not possible in her case. The article did not report whether she had been exposed to asbestos. The authors wrote that their literature review suggested this was the first report of this cancer presenting as a breast mass. They concluded that chest wall and chest cavity disease can present as breast lesions.

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 (a 'Case of the month' radiology teaching case)
• Who was studied: one 60-year-old woman with a 3-week history of a painless swelling in the left breast; the authors were from Chelsea and Westminster Hospital and Royal Marsden Hospital, London
• Exposure: Not reported for this patient: the article gives no asbestos exposure history. In the discussion, the authors state as general background that the link between malignant pleural mesothelioma and asbestos exposure is well established.
• Main results:
  • On examination, a 2 cm by 2 cm soft, lobulated mass was felt in the upper inner quadrant of the left breast
  • The screening mammogram showed no mass lesion
  • Ultrasound showed a well-defined, hypoechoic mass deep to the pectoralis muscle
  • The chest radiograph showed a moderate-sized left pleural effusion with irregular pleural thickening
  • CT showed a mass in the left anterior chest wall with destruction of the costochondral junction, associated with a large left pleural effusion
  • The needle aspirate was inadequate, so a diagnostic excisional biopsy of the chest wall mass was performed under general anaesthetic
  • Histopathology established malignant pleural mesothelioma
  • The authors described this as a case in which surgical pleural resection was not possible
• The authors' conclusion: The authors concluded that not all breast masses arise from the breast itself, and that chest wall lesions and intrathoracic disease can present as breast lesions. They stated that their literature review suggested this was the first report of malignant pleural mesothelioma presenting as a breast mass.

Topics

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

Related studies

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• GATA-3 and FOXA1 expression is useful to differentiate breast carcinoma from other carcinomas — D.G. Davis, M.T. Siddiqui, et al. (2016)
• An ultrastructural comparison of mesotheliomas with adenocarcinomas of the lung and breast — M.J. Warhol, J.M. Corson (1985)
• Expression of calretinin by breast carcinoma and the potential for misdiagnosis of mesothelioma — G. Powell, H. Roche, et al. (2011)
• Differential Diagnosis of Epithelioid Malignant Mesothelioma With Lung and Breast Pleural Metastasis: A Systematic Review Compared With a Standardized Panel of Antibodies-A New Proposal That May Influence Pathologic Practice — N. Le Stang, L. Burke, et al. (2020)

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