Breast metastases from extra-mammary malignancies, especially those mimicking primary inflammatory breast carcinoma, are extremely rare. We report here two cases of inflammatory breast metastases from gastric or ovarian cancer. Both patients, who had prior advanced malignant disease, presented with unilateral breast redness and swelling with peau d'orange sign, resembling primary inflammatory breast cancer or acute mastitis. Breast biopsy revealed poorly differentiated adenocarcinoma with signet-ring cells or clear cell carcinoma in the lymphatic vessels and the parenchyma without an in situ lesion, similar to primary lesions of the stomach or ovary, respectively. Immunohistochemical staining for estrogen receptor, progesterone receptor, and gross cystic disease fluid protein 15 was of value for correct diagnosis. Since breast metastasis is a sign of poor prognosis of the primary malignant disease, the possibility of breast metastasis should be considered in appropriate patients to preclude unnecessary major surgery.
An adenocarcinoma of the second portion of the duodenum in a 26-year-old male is presented. The patient was suffering from pain in the epigastrium. Immunofluorescent studies revealed that it consisted almost exclusively of cells with a distincly positive somatostatin-like immunoreactivity. Ultrastructurally, the cytoplasm of the tumor cells had numerous large round granules (about 400 micrometers) with variable electron density. Most of these cells closely resembled the D cells normally seen in the duodenum and the islets of the pancreas, although a few argyrophil cells could be demonstrated by light microscopy. Radioimmunoassay of extracts of the tumor revealed a large amount of somatostatin (2260 pg/mg); substance P and VIP were detected also. Somatostatinoma has been known to occur in the pancreas, but this seems to be the first somatostatinoma found in the intestine.
We report an unusual case of granulomatous hypophysitis in which visual impairment, meningitis and hypopituitarism in a 76-year-old female were associated with radiological evidence of a pituitary mass. The sellar lesion was indistinguishable from pituitary tumor on neuroimaging studies, but the recovery of visual acuity and visual field abnormalities together with the improvement of pituitary function after steroid administration indicated that the mass lesion was due to an inflammatory disease of the pituitary gland. The pituitary tissue obtained by transsphenoidal hypophysectomy revealed granulomatous inflammatory cell infiltration with epithelioid cells and scattered multinucleated giant cells. Although a causal relationship with meningitis was not ascertained, possible exposure of the CSF space to the autoimmune inflammatory process of the pituitary gland was likely in view of the positive pituitary antibody reaction and radiological evidence of suprasellar extension. This entity should be considered when evaluating patients with a pituitary mass, hypopituitarism and meningitis.
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