|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 197-198
Invasion of lung cancer into breast: The first case report
D Unal1, A Oguz2, A Tasdemir3, A Koc4
1 Department of Radiation Oncology, Kayseri Education and Research Hospital, Kayseri, Turkey
2 Department of Medical Oncology, Kayseri Education and Research Hospital, Kayseri, Turkey
3 Department of Pathology, Kayseri Education and Research Hospital, Kayseri, Turkey
4 Department of Radiology, Kayseri Education and Research Hospital, Kayseri, Turkey
|Date of Web Publication||5-Feb-2016|
Department of Radiation Oncology, Kayseri Education and Research Hospital, Kayseri
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Unal D, Oguz A, Tasdemir A, Koc A. Invasion of lung cancer into breast: The first case report. Indian J Cancer 2015;52:197-8
Synchronous primary lung and breast cancer is very rare., To the best of our knowledge, there is no information about the invasion of lung cancer into breast. In this report, we present the first case in the English language literature of invasion of lung cancer into breast.
A 68-year-old female patient was admitted with increasing severity of cough and chest pain for 6 months. Physical examination revealed that the lung sound amplitude of the right lung significantly decreased from the middle of the scapula. In addition, a 3 cm × 3 cm mass was palpated on the right anterior chest wall. 18F-fluorodeoxyglucose-positron emission tomography revealed that an 11 cm × 14.5 cm mass (standardized uptake value [SUV: 16.4]) occupying upper, middle and lower lobes of the right lung, which invaded the chest wall and mediastinal tissues, a conglomerate soft-tissue mass (SUV: 17.2) of approximately 4.3 cm × 2.6 cm in size in the right hemithorax, which were thought as intercostal lymph nodes and paracaval lymph nodes (SUV: 7), the largest of which was 1.5 cm. Transthoracic fine needle aspiration biopsy was performed from the largest lesion. Cytological examination was suggestive of squamous cell carcinoma [Figure 1]. Breast ultrasound revealed that conglomerate solid hypoechoic lesions. Ultrasound-guided tru-cut needle biopsy of the breast lesions was performed due to the possibility of second primary. The histopathology was reported as a malignant tumor. Immunohistochemical analysis of biopsy specimens showed a negative staining with estrogen receptor, progesterone receptor, c-erbB2, the gross cystic disease fluid protein-15, cytokeratin 5/6 (CK5-6) and CK7 and a positive staining with P63, which is a specific marker for squamous cell carcinoma [Figure 2]. As a result of radiological [Figure 3] and pathological assessment, the case was thought as an invasion of lung cancer into breast. Patient died 45 days after diagnosis of cancer.
|Figure 1: Cytological appearance of the epithelial tumor cells with keratinized cytoplasm (papanicolaou stain, magnification × 40)|
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|Figure 2: A positive immunohistochemical staining with P63 (magnification × 20)|
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|Figure 3: White arrows indicate the primary tumor in the lung while yellow arrow shows the breast invasion of this tumor|
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In the present patient, we thought that cancer in the breast was either synchronous primary breast cancer or an invasion of lung cancer into breast. Therefore, breast biopsy was performed. Immunohistochemical analysis revealed that a negative staining with immunohistochemical markers of breast cancer and a positive staining with P63, which is a specific marker for squamous cell carcinoma. As a result of radiological and immunohistochemical findings, cancer in the breast was thought as an invasion of lung cancer into breast.
Chest wall involvement is seen in approximately 5% of patients with newly diagnosed non-small cell lung cancer and is a poor prognostic factor. This patient's prognosis was also poor; patient died a short time after the diagnosis before we could start treatment.
In conclusion, invasion of lung cancer into breast is seen extremely rare, but it should be kept in mind in the presence of a breast mass in patients with lung cancer.
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[Figure 1], [Figure 2], [Figure 3]