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Bilateral Breast Metastasis of Atypical Pulmonal Carcinoid
*Corresponding author: Pavlišta D, Department of Oncogynecology, Clinic of Obstetrics and Gynecology of the 1st Faculty of Medicine of Charles University and General Hospital in Prague, Czech Republic.
Received: February 28, 2020; Published: March 05, 2020
The breast is an uncommon site of metastasis. We report a case of bilateral metastasis of atypical pulmonal carcinoid in the breast. Review of the literature has demonstrated only a few cases of carcinoid metastatis in a single breast, but not bilateral. In spite of the rarity of this finding, the differential diagnosis between primary and metastatic carcinoid or malignant tumor of the breast at all, should be considered in view of the different management of these two settings. Immunohistology has proved a very helpful method in this field. Accurate diagnosis of breast metastasis is important to avoid unnecessary treatment.
From the patient´s history: her mother died of breast cancer and she had a breast surgery for a fibroadenoma in 1993. In January 2001 she had undergone an upper lobectomy of the right lung for an atypical bronchial carcinoid ( pT1, N2, M0, G2). An adjuvant radiotherapy was performed for lymph node metastasis. A follow-up after one year revealed a small metastatic tumor in the epigastrium. Additional metastasis were not found. She received six cycles of chemotherapy containing Vepeside and Cisplatin.
Our patient, a 42-year-old woman, presented to the tumor bord for surgical treatment of bilateral lesions in the breast. The results of the mammogram and physical examination revealed 1x1 and 2x1 cm masses, bilateral in the upper outer quadrant of the breast and was thought to probably be benign. The results of the sonography confirmed these findings. There was no sign of axillary lymphadenopathy. The patient refused a core-cut biopsy.
The patient underwent bilateral lumpectomy. The result from the frozen section was not evident, so surgery was not extended. The final histological examination revealed two masses with ductal carcinoma, NOS (non-other specify), with lymphangiosis carcinomatosa, grading 3. Additionally, immunohistochemical analysis of all tumors was performed. The immunological features of lungcells, nodi metastasis and breast tumor were compared. This demonstrated positive results in all parameters typical for carcinoid tumor (chromogranin, NSE, Bombesin, Calcitonin, HISL 19) and negative results for ACTH and hCG. This description was compatible with multifocal metastasis of a carcinoid tumor.
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