Mesothelioma presenting as a breast lump: when is a breast lump not a breast lesion?

Our plain-English summary of Mesothelioma presenting as a breast lump: when is a breast lump not a breast lesion?, by S.L. Savaridas, G.D. Bristow (BJR Case Reports, 2015).

The study

• Authors: S.L. Savaridas, G.D. Bristow
• Journal: BJR Case Reports
• Published: 2015;1(3):20150002
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A case of mesothelioma presenting as a breast lump. Relevant imaging is reviewed and the differential diagnoses discussed. The absence of the pectoralis muscle on mammogram is a potentially ominous sign which should not be assumed to be due to technical factors.

In plain English

This case report described a 71-year-old woman at a UK breast clinic (North Tyneside General Hospital) with a lump in her left breast that felt fixed to the chest muscle (pectoralis). Her first mammogram was reported as normal. Ultrasound showed an ill-defined mass deep in the breast that seemed to arise from the pectoralis muscle, and core needle biopsies were taken. MRI showed a 16 by 12 by 7 cm mass replacing most of the pectoralis major muscle and extending into the chest cavity, with fluid around the left lung (pleural effusion). CT showed the mass also involved the pleura and the left rectus abdominis muscle. The biopsy diagnosed mesothelioma, and she was referred for consideration of palliative chemo-radiotherapy. She had not known of any asbestos exposure, but on questioning said she had washed the clothes of her husband, who worked as a joiner. Her mammogram showed absence of the full pectoralis muscle shadow on the left. The authors concluded this is a potentially ominous sign that should not be assumed to be due to technical factors.

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
• Who was studied: One 71-year-old woman seen at the symptomatic breast clinic of North Tyneside General Hospital, UK, with a palpable mass in the left upper outer quadrant of the breast. The date of presentation is not given (article received January 2015).
• Exposure: Possible domestic exposure: she had not been aware of asbestos exposure, but on questioning reported washing the clothes of her husband, who worked as a joiner. No fiber type, product or dose is given.
• Main results:
  • The initial mammogram was reported as normal (M1, no abnormality).
  • Ultrasound found no abnormality at the site of the lump, but showed an ill-defined mass (6 by 2 by 4 cm) deep in the posterior medial breast that seemed to arise from the pectoralis muscle. Three 14-gauge core needle biopsies were taken.
  • MRI showed a large mass (16 by 12 by 7 cm) arising from and replacing most of the left pectoralis major muscle, extending into the thoracic cavity, with no discrete breast lesion and a moderate-sized left pleural effusion.
  • CT showed the soft-tissue mass involving the left lateral chest wall muscles and the left rectus abdominis, with involvement of the costal cartilages and pleura, lobulated pleural thickening, a large left pleural effusion, and encasement of the left subclavian artery, vein and brachial plexus.
  • The original core biopsy diagnosed mesothelioma.
  • The patient's left mammogram (mediolateral oblique view) showed absence of the full pectoralis muscle shadow.
  • The patient was referred to oncology for consideration of palliative chemo-radiotherapy.
• The authors' conclusion: The authors concluded that absence of the pectoralis muscle on a mammogram is a potentially ominous sign that should not be assumed to be due to technical factors, and that not all breast lumps arise from breast tissue, so tissue down to the chest wall should be fully imaged.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Malignant mesothelioma presenting as a breast mass — A. Aujayeb, H. Clague, et al. (2012)
• Metastatic pleural mesothelioma presenting in a breast fine needle aspiration specimen — P.W. Shield, D.L. Ribu (2017)
• Malignant peritoneal mesothelioma presenting as a complex omental lesion — R. Sudanthiram, C. Vemulapalli, et al. (2012)
• Sarcomatoid Mesothelioma With New Pancreatic Lesions Presenting As Acute Pancreatitis: A Case Report — F. Al-Moussally, F. Alamin, et al. (2024)
• Lump sum compensation for asbestos related lung disease — T. Williams, P. Slade, et al. (1998)
• Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? — P.J. Ross, S. Ashley, et al. (2004)

Browse return to medical research.