Metastases to the breast: differential diagnosis from primary breast carcinoma

Our plain-English summary of Metastases to the breast: differential diagnosis from primary breast carcinoma, by B. Vergier, M. Trojani, I. de Mascarel, et al (Journal of Surgical Oncology, 1991).

The study

• Authors: B. Vergier, M. Trojani, I. de Mascarel, J.M. Coindre, A. Le Treut
• Journal: Journal of Surgical Oncology
• Published: 1991;48(2):112-6
• Cited by: 169 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Eight patients with breast metastases from primary tumors other than breast carcinoma were studied: 3 malignant melanomas, 2 rhabdomyosarcomas, 1 malignant mesothelioma, 1 appendiceal carcinoid, and 1 epidermoid cervical carcinoma. All had mammographic, histopathologic, and immunohistochemical examinations. The main problem was differential diagnosis from primary breast carcinoma. History of extramammary primary tumor was helpful but breast metastasis was the first clinical feature in 2 cases. Patients had noticed palpable, round, rapid growth masses which were mammographically benign. Pathologic diagnosis was difficult and immunohistochemical studies necessary, whenever the proliferation had histologic features of primary breast carcinoma or when no primary tumor was known. However, some histologic features were of value for diagnosis of metastasis: atypical histologic features for a primary breast carcinoma, a well-circumscribed tumor with multiple satellite foci, the absence of an intraductal component, and the presence of many lymphatic emboli. In adults, the most frequent types of tumors metastasizing in the breast are malignant melanoma and neuroendocrine-like tumors, especially small cell carcinoma and carcinoid. In children, rhabdomyosarcoma is the most common. Accurate diagnosis of breast metastasis is important to avoid unnecessary mastectomy and to implement an appropriate systemic therapy.

In plain English

This article was a case series from the Fondation Bergonié in Bordeaux, France. Over 10 years, the authors studied 8 women whose breast tumors had spread there from cancers that started elsewhere: 3 malignant melanomas, 2 rhabdomyosarcomas, 1 malignant mesothelioma, 1 carcinoid of the appendix and 1 epidermoid cervical carcinoma. The article does not mention asbestos. The mean age when the breast metastasis was found was 41 years (range 16 to 69). Mammography showed a mass in every case, measuring 1.2 to 10 cm across. Five patients died within 2 years or less. In 3 cases, one of them the mesothelioma, special immunohistochemical stains were used to confirm the diagnosis. The woman with mesothelioma had had breast carcinoma 20 years earlier. She now had abdominal pain, ascites and a breast nodule, and her tumor contained both epithelial and sarcomatous components. The authors concluded that metastatic cancer in the breast must be confirmed by appropriate histopathologic and immunohistochemical examination, to avoid unnecessary mastectomy and to provide suitable treatment.

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 series (8 cases)
• Who was studied: 8 women with breast metastases from non-breast primary tumors, seen over a 10-year period (years not stated) at the Fondation Bergonié, Bordeaux, France. Patients with metastases from the other breast and with leukemia or lymphoma were excluded.
• Exposure: Not studied. The article does not mention asbestos or any other exposure. The primary tumors were 3 malignant melanomas, 2 rhabdomyosarcomas, 1 malignant mesothelioma, 1 appendiceal carcinoid and 1 epidermoid cervical carcinoma.
• Main results:
  • Primary tumors in the 8 cases: 3 malignant melanomas, 2 rhabdomyosarcomas, 1 malignant mesothelioma, 1 carcinoid of the appendix, 1 epidermoid cervical carcinoma.
  • In 6 cases the breast metastasis appeared on average 4 years after the primary tumor was found. In 2 patients it appeared at the same time as the primary tumor.
  • Mean age of the 8 patients when the breast metastasis was discovered was 41 years (range 16-69).
  • On mammography the metastases measured 1.2-10 cm in diameter, with a mean size of 4 cm.
  • No microcalcifications were seen on mammography. Spiculation was present in one case.
  • 5 of the 8 patients died within 2 years or less.
  • Under the microscope, no in situ change was found in the breast ducts or lobules in any of the tumors.
  • Immunohistochemical studies confirmed the diagnosis in the last 3 cases: an achromic melanoma, the carcinoid and the malignant mesothelioma.
  • The patient with malignant mesothelioma had a history of primary breast carcinoma 20 years earlier.
  • The patient with malignant mesothelioma presented with constipation, abdominal pain, ascites and a breast nodule.
  • The mesothelioma metastasis in the breast consisted of a mixture of epithelial tubulopapillary and sarcomatous components.
  • The mesothelioma cells stained positively for cytokeratin, and to a lesser extent for EMA and vimentin.
• The authors' conclusion: The authors concluded that metastatic cancer in the breast must be confirmed by appropriate histopathologic and immunohistochemical examination, to avoid unnecessary mastectomy and to provide suitable treatment.

Topics

Medical terms in this study, explained in our Lexicon: Differential Diagnosis, Carcinoma, Malignant Mesothelioma, Metastasis, Systemic Therapy.

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