Secondary breast cancer: a 5‐year population‐based study with review of the literature

Abstract

Secondary tumours in the breast are rare. Based on literature, an incidence of 0.4-2% is reported. In this population-based study, secondary breast tumours from a 5-year period (2001-2005), not including metastasis from contralateral breast carcinoma, were reviewed (Vestfold County, Norway). A total of 722 patients with breast malignancies were found in this population (89.3% from Vestfold County Hospital). Ten of these, approximately 1.4%, were metastatic tumours, representing four cutaneous melanomas, three pulmonary carcinomas and three malignant lymphomas. The tumours were often solitary, palpable and close to the skin. Radiologically, the lesions mostly resembled primary carcinomas by mammography and ultrasound, which differs from other studies. Comparison with a known primary tumour and use of immunohistochemical profiling is of crucial importance. Melanoma markers (Melan-A, HMB-45, S-100 protein), lung cancer markers (Cytokeratins, TTF1, Chromogranin, Synapthophysin) and lymphoid markers (CD3, CD20) usually help to confirm a secondary breast tumour diagnosis. This approach is especially indicated in diffusely growing tumours with lack of glandular structure and high-grade cytological features, and staining for ER and GCDFP15 may be helpful. Thus, the diagnosis of a breast metastasis may be suspected by careful mammography and ultrasound imaging, although some cases have atypical radiological features, and histological examination might be necessary to ensure a correct diagnosis and appropriate treatment.

Breast metastasis from a pulmonary adenocarcinoma: Case report and review of the literature

“…Similar findings from other authors are rare (7,17,25,30). Distinguishing a breast metastasis from a primary mammary adenocarcinoma, based on mammographic findings, may be extremely difficult due to the wide range of imaging manifestations of the metastatic lesions (4,5,18). Thus, metastasis can mimic a primary malignancy or even a benign breast tumor (4,5,18).…”

“…4). (4,5,(9)(10)(11)(12)(19)(20)(21)(22)(23)(24)(25)(26)(27). Twelve of these cases were classified as adenocarcinomas (5,9,12,19,(21)(22)(23)25).…”

“…The majority of breast metastases present as palpable, rapidly growing, well-circumscribed and painless breast masses with predilection to the upper outer quadrant (2,7,17,21,22). Unlike primary tumors, the vast majority of metastases do not demonstrate retraction of the skin or nipple, despite their superficial location (5,22). However, in our patient, the lesion was poorly defined and skin redness was observed.…”

“…Although primary breast cancer is the most common malignancy of adult females, metastatic involvement of the breast is rare, with a reported frequency of 0.4-1.3% in clinical series (2)(3)(4)(5). Despite its rarity, metastatic breast disease is an significant diagnostic clinical problem, as its treatment differs greatly from that of primary breast cancer.…”

“…In 1907, Sitzentfrey was the first to publish a case of ovarian carcinoma metastatic to the breast (6). To date, a wide variety of malignancies have now been reported to metastasize to the breast and according to the literature, the most common primary tumors are melanomas and haematological malignancies (5)(6)(7). The lung is the most common cancer site in terms of incidence and mortality; however, there have only been a few published cases of pulmonary carcinomas metastasizing to the breast (8)(9)(10)(11)(12).…”