|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 9-10
Nasopharynx carcinoma: A rare primary for bilateral breast metastasis
KU Vaishnav, S Pandhi, TS Shah, A Chaudhary, S Sethi
Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat State, India
|Date of Web Publication||3-Feb-2016|
K U Vaishnav
Department of Radio-diagnosis, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat State
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vaishnav K U, Pandhi S, Shah T S, Chaudhary A, Sethi S. Nasopharynx carcinoma: A rare primary for bilateral breast metastasis. Indian J Cancer 2015;52:9-10
|How to cite this URL:|
Vaishnav K U, Pandhi S, Shah T S, Chaudhary A, Sethi S. Nasopharynx carcinoma: A rare primary for bilateral breast metastasis. Indian J Cancer [serial online] 2015 [cited 2019 Dec 15];52:9-10. Available from: http://www.indianjcancer.com/text.asp?2015/52/1/9/175593
A 28-years-old female patient presented to our hospital in April 2009 with complaints of right cheek swelling. The patient was referred to our department for magnetic resonance imaging (MRI) para-nasal sinuses. MRI showed presence of a soft tissue mass lesion involved the posterior wall of nasopharynx [Figure 1].
|Figure 1: Magnetic resonance imaging of nasopharynx, coronal T1w and post-contrast T1 w images show hypointense soft tissue mass, which involves posterior wall of nasopharynx, extends into ethmoid air cells and laterally erodes medial orbital wall and infiltrates retro-orbital fat and medial rectus muscle. Post-contrast axial T1w and coronal T1w images show mild to moderate enhancement|
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Bilateral enlarged level Ib, II, and III lymph nodes were present. The radiological diagnosis of nasopharyngeal malignancy was established [Figure 2]a. Ultrasonography-guided biopsy of the right cervical lymph node was performed, and histopathology and immunohistochemistry revealed metastatic undifferentiated nasopharyngeal carcinoma (NPC) [Figure 2]b.
|Figure 2: Microphotograph shows (a) large tumor cells with hyper chromatic nucleus, irregular nuclear membrane, and scanty to moderate cytoplasm. Features are suggestive of undifferentiated malignant tumor. As the patient is a known case of nasopharyngeal carcinoma, possibility of metastatic nasopharyngeal carcinoma undifferentiated type is favored; (b) Microphotograph shows metastatic nasopharyngeal carcinoma in cervical lymph node. (H and E, ×200)|
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The patient was referred for chemotherapy. She received 2 cycles of paclitaxel, 5-fluorouracil and 3 cycles of paclitaxel, cisplatin, and 5F-U. Post-chemotherapy, she underwent a repeat MRI to assess response. No significant change in the size and extent of the lesion was seen. Then, the patient was referred for radiotherapy. She received 66 Gray/33 fractions over a period of a month.
Patient's general condition was not too much bad before presenting with breast masses.
Other investigation like ultrasound abdomen and pelvis, chest X-ray were normal. No evidence of metastasis elsewhere.
Two months later, she presented with complaints of multiple bilateral painless, palpable breast lumps. She was referred for mammography. Clinically, there were multiple well-defined lumps in both breasts, not fixed to the skin or underlying muscle. Mammography showed dense parenchymal pattern in both breasts without micro calcification, nipple retraction, or skin thickening. No significant lymphadenopathy was noted in either axillary region [Figure 3]. Ultrasound showed multiple well-defined lobulated hypoechoic lesions in both breasts. On color Doppler study, few of the lesions showed minimal internal vascularity [Figure 4].
|Figure 4: Ultrasound with color Doppler imaging shows multiple lobulated hypoechoic lesions with internal vascularity|
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Ultrasound-guided biopsy of the breast lesion was performed, and histopathology was consistent with the metastatic poorly-differentiated carcinoma of the nasopharynx. The patient was then referred for chemotherapy.
Metastases from undifferentiated NPC cancers are extremely rare, and only 3 well-documented cases have been reported in the English literature.
Although primary breast carcinoma is a very common tumor, the incidence of breast involvement by other malignancies is quite, low about 0.5-6%. The most common sources of metastases to breast are primary tumors from the opposite breast, melanoma, and lymphoma., The relatively low incidence of breast metastases from head and neck cancers is probably due to its low tendency to disseminate. Primaries from head and neck cancers are rare, and a primary from NPC is extremely rare. One of the first cases of nasopharyngeal carcinoma that had metastasized to the breast was published in 1991. Diagnosis and management of metastases to the breast can present with difficulties to the radiologist and the clinician. An accurate differentiation of metastatic from primary lesion is of crucial importance, because the treatment planning and prognosis shall differ significantly. It has been observed that solitary lesion is the most common form of clinical presentation (85%), with diffuse involvement in 4%. Metastatic lesions of the breast are more likely to be superficial; less fixed to the surrounding tissue, well-marginated, without micro calcifications, and does not show rapid growth. Therefore, further additional radiological study such as MRI may provide useful information. The prognosis of patients presenting with metastases to the breast is poor.
To conclude, bilateral breast metastases from the undifferentiated carcinoma of nasopharynx are extremely rare. Breast metastases are commonly confused with more common primary carcinoma of breast, so diagnosis is based on the fine needle aspiration cytology of the lesion, which is helpful in the appropriate treatment planning of the patient.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]